Peroneal Tendon Tear and Dysfunction

What is peroneal tendon dysfunction?

A peroneal tendon tear is just one of three types of peroneal dysfunction. 

• Peroneal tendonitis refers to inflammation of the tendons in the lower leg and ankle.
• Peroneal tendon subluxation (or a strained peroneal tendon) occurs when the tendons are elongated (overstretched) or pulled away from their normal structures.
• Peroneal tendon tears occur when the tendon(s) are partially or completely separated. 

All three are predominant causes of ankle instability and pain and can occur from a traumatic ankle injury or chronic stress on the joint.

What is a peroneal tendon tear? 

There are two tendons in your ankle that connect your lower leg muscles to your foot, providing stability and strength. They start as the peroneus longus and brevis muscles near your knee, then run down the outside of your leg, becoming tendons. 

The tendons continue through the lateral ankle joint and to the outside edge of your foot. Together with the fibularis tertius, they form the peroneal muscles. Most injuries happen behind the lateral malleolus, the large bone on the outside of your ankle joint, where the tendons form a pulley-like system.

Peroneal tendon tears can occur from a traumatic injury, such as an ankle sprain that overstretches the tendons and ligaments. However, they can also develop due to overuse such as repetitive activities with side-to-side movements, like basketball, that consistently put stress on the tendons. 

Usually, a chronic use injury occurs in conjunction with poor mechanics of the ankle and foot. For example, if loose tendons rub on the edge of the fibula instead of in their normal position behind the bone, they may fray and slowly tear, resulting in tendinosis. Additionally, certain foot conditions such as high arches can put you at risk for peroneal tendon injury.

Both acute or chronic conditions can result in one or both of the tendons being torn. It is more common to tear the peroneus brevis tendon than the peroneus longus tendon.

What are the types of peroneal tendon tears? 

The cause of a tendon tear is associated with the type. There are two types of peroneal tendon tears:

• Acute peroneal tendon tears are the result of an injury, like dislocation, causing the band of tissue to tear. In most cases of acute tears, you will be able to pinpoint exactly when the ankle pain started.
• Chronic peroneal tears happen gradually over a longer period of time and are caused by continued stress on the tendons. Your pain may not be consistent and can flare from time to time.

In addition, you can have a mild to severe tear of the tendon, usually classified as grades.

• Grade I is mild; the tendon is usually overstretched with minimal to no tearing.
• Grade II is moderate, in which the tendon shows a partial tear.
• Grade III is severe and presents with a complete tear of the tendon, sometimes referred to as a tendon rupture.

What does a peroneal tendon injury feel like?

Peroneal tendon tears can present with common symptoms focused on the ankle and foot.

Symptoms of symptoms of torn peroneal tendon or injury include:

• Pain in the outer ankle
• Increased pain during inversion or eversion of the foot (turning and stretching it outward or inward, side to side)
• Warm to the touch where the tendon is injured
• Ankle swelling
• Reduced range of motion
• Ankle instability, especially around the outside of the ankle
• Ankle and foot weakness

Degenerative tears due to overuse may cause symptoms that come and go or occur gradually. Acute tears due to injury cause sudden and easily identifiable pain.

How are peroneal tendon conditions diagnosed?

Nearly all foot and ankle diagnoses start with an exam. Our doctors will ask you questions about your medical history and then check for pain and reduced ankle motion. If there is pain noted along the course of the peroneal tendons, imaging, such as an X-ray, may be needed to check foot alignment and look for the presence of fractures. 

We also have access to ultrasound to examine the gliding of the tendons, looseness (laxity), and check for any small tears or scar tissue within the tendons.

If there is a suspected tear, magnetic resonance imaging (MRI) may be necessary to check the region to see how large or extensive the tear is. MRIs can also be used to diagnose ankle damage such as ligament tears, arthritis, or cartilage damage.

What are the options for peroneal tendon tear treatment? 

At UFAI, we always opt for conservative treatment options when possible. However, if nonsurgical treatment is insufficient, our foot and ankle surgeons are highly trained in surgical techniques for peroneal tendon tears.

Conservative care options for a peroneal tendon injury 

Conservative treatment options include:

• • Immobilization through a cast, splint, boot, or brace to allow the area to rest and heal.
  • Nonsteroidal anti-inflammatory medications (NSAIDs) to reduce inflammation and pain associated with tendinitis.
  • Rest, ice, compression, and elevation (RICE).
  • Physical therapy to increase strength and mobility after the soft tissues have healed.

If after six weeks the tendon is not responding to treatment, surgery may be indicated.

How is a peroneal tendon tear treated with surgery? 

If surgery is indicated for the repair of your peroneal tendon, our doctor will determine the most appropriate procedure for your condition and lifestyle.

One option is tendon debridement, in which we create a small opening in the back of the ankle to clean out damaged and inflamed tissue within the sheath that covers the tendon. Once cleaned, scar tissue should fill in the sheath without any surgical repairs required.

Tendon repair can occur in a few different ways. We’ll access the tendon sheath to suture the tear or anchor the loose tendon to it. During tenodesis, a ruptured, unattached peroneal tendon can be reattached to a healthy tendon or bone. If the tendon must be removed, our doctor may use a tendon graft to repair the damaged structure, placing a connective tissue from elsewhere in your body (autograft) or donor tissue (allograft) in place of the damaged tendon. If there is cartilage damage or loose or torn ligaments, these will be repaired at the same time.

Peroneal tear operations are performed at one of our out-patient surgery centers, under general anesthesia. Generally, peroneal tendon surgeries take around one-and-a-half hours to perform.

What can you expect after peroneal tendon repair surgery? 

After orthopedic surgical repair of your torn peroneal tendon, the best medicine is rest and foot elevation. It is essential to keep weight off the foot. 

We may equip you with an ankle splint for added support and immobilization. You will return to our office in about two weeks to have your sutures removed. At that time, your ankle splint will be replaced by either a short cast or a splint known as a cam walker. You may begin weight-bearing activities using the cam walker in about a month. 

You can return to wearing normal footwear three to four months after surgery.

Why physical therapy is essential for your recovery 

Working with one of our physical therapists to strengthen your ankle will play a key role in your recovery, and be prescribed 8-12 weeks after the procedure. Physical therapy usually involves learning an ankle stretching routine and performing ankle and lower leg strengthening exercises.

By following a physical therapist’s routine, we find that many patients can return to sports and activities within six months.

UFAI doctors are experienced in peroneal tendon tears

The physicians at the University Foot & Ankle Institute have decades of combined experience treating all forms of adult foot and ankle injuries. Our sports medicine experts use the latest technologies available to successfully diagnose and treat peroneal strains and tears. 

For a consultation, please call (877) 736-6001 or make an appointment online now.

University Foot and Ankle Institute is conveniently located throughout Southern California and the Los Angeles area. Our foot and ankle surgeons are available at locations in or near Santa Monica, Beverly Hills, West Los Angeles, Sherman Oaks, the San Fernando Valley, El Segundo, the South Bay, LAX, Calabasas, Agoura Hills, Westlake Village, Valencia, Santa Clarita, and Santa Barbara.

 

Peroneal tendon tear FAQs 

 

Can a peroneal tendon tear heal on its own?

A peroneal tendon injury usually won’t go away on its own. Mild tears will need conservative treatment, like rest and ice, to heal, while more severe tears may require surgical repair.

 

Can you walk with a peroneal tendon tear?

Minor tears of the peroneal tendons often won’t prevent you from walking, though you may notice pain and instability. A complete rupture of the peroneal tendon can cause such instability in the ankle joint that you may not be able to walk properly, especially without significant pain.

 

How is a peroneal tendon tear different from an Achilles tendon tear?

You can generally tell a peroneal tendon injury from an Achilles tendon injury by the location of the pain. Peroneal tendons cause pain on the outside of the ankle and outer part of the foot. Alternatively, Achilles tendon issues cause pain in the back of your heel that can sometimes radiate upward to the calf.