PERONEAL TENDON TEARS
The peroneus longus and peroneus brevis are two very important muscles in the leg, which convert to tendons in the ankle, and attach to the bones in the foot. They are located behind the fibula bone on the outside of the ankle and course along the lateral side of the foot. These tendons have functionally important roles in the mechanics of the foot and ankle. Particularly, these tendons function to increase stability at the ankle, which is very important in athletes or in patients who have recurrent ankle sprains. In fact, an ankle sprain can cause damage to the peroneal tendons by overstretching them. Symptoms of peroneal tendon pathology can include weakness at the ankle, feelings of instability, recurrent ankle sprains, swelling behind the fibula, or pain on the side of the ankle and the foot.
Sometimes peroneal tendon issues will respond to conservative treatment. A brace or an insole to offload stress on the tendons can be beneficial. Some patients will find that the pain and swelling may respond to anti-inflammatory medications. Topical anti-inflammatories can also be used directly on the skin overlying the tendons to deliver a localized effect. Physical therapy may be initiated to strengthen the tendons and decrease symptoms of ankle instability.
If conservative treatment fails to offer relief, then surgery may be beneficial. There are several different procedures to address peroneal tendon problems. Most of the time, the tendons are salvageable and can be repaired primarily. Occasionally, one tendon may be so severely damaged that it must be sewn or transferred to the other tendon. In chronic cases, with severe tissue degeneration of both tendons, then a tendon transfer from another part of your foot, or an allograft tendon (tendon from a donor) reconstruction may beneficial. Related foot problems may be addressed simultaneously, such as deepening the groove where the tendons course behind the fibula to decrease pressure on the tendons. Patients with excessively high arches may be more prone to ankle sprains and recurrent peroneal tendon tears, thus in these patients, it may be recommended to flatten the high arch (see cavus foot) to completely correct the problem.
The timing of recovery will depend on the findings at the time of surgery. The operation is generally done on an outpatient basis. Many patients choose to have a popliteal nerve block performed to help with postoperative pain control. You will be discharged with a prescription for pain medicine to also help control your pain. Much of the time immediately after surgery is spent resting and elevating the leg to decrease swelling. We generally recommend you keep your leg elevated as much as possible during the first week after surgery. The ankle is usually immobilized for 4-6 weeks to promote healing. Sometimes, it is important not to put weight on the ankle during the first six weeks and the use of crutches, a walker, or a rolling knee scooter can help with mobilization. You will be discharged home in a splint and then we will see you in office to check your incision and place a cast. Typically, at 4-6 weeks following surgery, the cast is changed to a walking boot. Patients wear the boot for about 6 weeks as they gradually transition back to weight bearing and begin range of motion exercises. Physical therapy is an important component of the recovery from peroneal tendon surgery and is usually commenced at 6-12 weeks.