Peroneal Tendon Tear

A peroneal tendon tear is a painful ankle injury that can keep athletes and active people from playing. The peroneal tendons are on the outside of the ankle. They help keep the foot and ankle stable when moving.

When these tendons tear or get damaged, it causes foot pain, swelling, and trouble walking. This makes it hard to put weight on the foot.

Peroneal tendon tears can happen suddenly, like from an ankle sprain, or slowly from too much use. If not treated right, it can get worse. This can lead to chronic ankle instability and less mobility. It’s important to see a doctor quickly if you think you have a tear.

In this article, we’ll look at the peroneal tendons, why they tear, and the signs of a tear. We’ll also talk about how to diagnose and treat it. Plus, we’ll cover ways to prevent future injuries. Knowing about this common ankle injury helps keep your feet safe and your life active and pain-free.

What is a Peroneal Tendon Tear?

A peroneal tendon tear is an injury to the peroneal tendons on the outside of the ankle and foot. These tendons, the peroneus longus and peroneus brevis, help keep the ankle stable and let the foot move. A tear can lead to lateral ankle pain and make the ankle unstable.

Peroneal tendon tears can be partial or complete. A partial tear stretches or frays the tendon fibers but doesn’t cut them all the way. A complete tendon rupture cuts the tendon in two, causing loss of function and stability.

Tears can happen suddenly from an injury like an ankle sprain or direct trauma. They can also develop slowly from overuse, repetitive stress, or ankle instability. Sports that involve a lot of lateral movement, like tennis, basketball, and soccer, increase the risk of peroneal tendon tears.

Symptoms include pain, swelling, and tenderness on the outer ankle. There may also be weakness or instability when walking or putting weight on the foot. Sometimes, a popping sensation is felt at the time of injury. Getting a quick diagnosis and proper treatment is key for recovery and avoiding long-term problems.

Anatomy of the Peroneal Tendons

The peroneal tendons are two key structures on the outer side of the ankle and foot. They are vital for stabilizing the ankle and preventing ankle injuries. Knowing about the peroneal tendons helps people understand foot pain from tears.

Peroneus Longus

The peroneus longus tendon starts at the upper fibula, the thin bone outside the lower leg. It goes down the leg, around the outer ankle, and attaches to the first metatarsal bone on the foot’s underside. It helps stabilize the foot’s arch and aids in pointing the foot down and outward.

Peroneus Brevis

The peroneus brevis tendon begins from the fibula, but it’s a bit lower and in front of the longus. It runs parallel to the longus, behind the outer ankle, and attaches to the fifth metatarsal bone. It works with the longus to stabilize the ankle and foot, mainly during weight-bearing activities.

The peroneal tendons balance the ankle and foot, stopping excessive inward rolling and supporting during movement. Injuries to these tendons can cause instability, weakness, and pain. It’s important to treat any suspected tears quickly to avoid more damage and ensure healing.

Causes of Peroneal Tendon Tears

Peroneal tendon tears can happen for many reasons. They can come from sudden injuries or from doing the same thing over and over. Knowing why this orthopedic condition happens is key to stopping it and treating it well. Let’s look at the three main reasons for peroneal tendon tears.

Acute Injury

Acute injuries, like ankle sprains or hitting the outer ankle, can tear the peroneal tendons. When the ankle twists or turns too much, the tendons can stretch too far. This can cause partial or full tears. Sports that need quick changes in direction, like basketball or soccer, increase the risk of such injuries.

Overuse and Repetitive Stress

Peroneal tendon tears can also come from doing the same thing too much. Running, dancing, or playing tennis can strain the tendons over time. This stress can cause tendinitis, which is inflammation and wear down of the tendon. If not treated, tendinitis can turn into a tear.

Ankle Instability

Chronic ankle instability, from past sprains or being born with it, can also lead to tendon tears. When the ankle ligaments are weak, the tendons have to work harder. This can cause them to get tired, inflamed, and eventually tear. People with unstable ankles are more likely to get hurt again, raising the risk of tendon tears.

Knowing why peroneal tendon tears happen helps prevent them. Good training, proper technique, and the right shoes can lower the risk of sudden injuries and overuse. Those with unstable ankles should talk to a doctor to fix the problem and avoid tendon tears.

Symptoms of a Peroneal Tendon Tear

The symptoms of a peroneal tendon tear can vary. Most people feel pain on the outside of their ankle and foot. This pain gets worse with activity or when pushing off the foot.

A popping sensation or sound may happen at injury time. Swelling and weakness are also common symptoms.

Other symptoms include:

The pain’s severity often matches the tear’s extent. Partial tears cause mild to moderate pain. Complete tears lead to intense pain and big limitations.

Chronic cases may start with aching or tenderness. If you have these symptoms, see a doctor. They can diagnose and treat the tear.

Early treatment helps avoid more damage. It also improves healing chances.

Diagnosing a Peroneal Tendon Tear

It’s important to accurately diagnose a peroneal tendon tear to find the best treatment. Patients with symptoms like pain, swelling, and ankle instability are checked. Healthcare professionals use physical exams and imaging tests to confirm the diagnosis and understand the injury’s severity.

Physical Examination

The healthcare provider will gently touch the affected area to check for tenderness and swelling. They might do tests like the resisted eversion test to check tendon strength. They also check ankle stability and movement to see if the injury affects the ankle’s function.

Imaging Tests

Imaging tests are key in confirming a peroneal tendon rupture and how bad the damage is. X-rays are first used to check for fractures or bone problems. But X-rays can’t see soft tissues like tendons.

Ultrasound imaging is a non-invasive and affordable way to see the tendons in real-time. It helps spot tears, inflammation, or other issues. MRI is the best for seeing tendon tears because it gives detailed images of soft tissues. An MRI can show where the tear is and how bad it is, plus any other injuries or conditions.

Healthcare professionals use physical exams and imaging tests together to accurately diagnose a peroneal tendon tear. This helps them create a treatment plan that fits each patient’s needs. Early diagnosis and treatment are key to preventing more damage and helping the patient recover well.

Non-Surgical Treatment Options

Many people with a peroneal tendon tear can find relief without surgery. These non-surgical methods are often the first choice for treating foot pain caused by this orthopedic condition. The right treatment depends on how bad the tear is and what the patient needs.

Rest and Immobilization

It’s important to rest the foot and ankle to help the tendon heal. Using crutches or a walking boot can keep the area stable. How long you need to rest and use a boot depends on the tear’s severity, usually a few weeks to months.

Physical Therapy

Physical therapy is a big part of treating peroneal tendon tears without surgery. A physical therapist will create a plan to help you:

Orthotics and Braces

Orthotics and ankle braces offer extra support and stability. They help reduce stress on the peroneal tendons. Custom orthotics fix any foot issues that might have led to the tear. Ankle braces prevent the foot from moving too much, protecting the tendon while it heals.

Surgical Treatment for Peroneal Tendon Tears

When non-surgical treatments fail, surgical repair might be needed for severe peroneal tendon tears or ruptures. This is often the case for those with ongoing pain, instability, or limited function due to this orthopedic condition. The surgery aims to fix the damaged tendons and restore their function.

The choice of surgery depends on the tear’s location, size, and the patient’s needs. Here are some common surgical options for treating peroneal tendon tears:

Debridement and Repair

This method involves removing damaged tendon parts (debridement) and stitching the healthy parts back together. The surgeon makes an incision on the outer ankle to find and repair the torn tendon. It works well for minor to moderate tears with good tissue.

Tendon Grafting

For severe tears or injuries with poor tendon quality, a tendon graft might be used. The graft can come from another tendon in the body (autograft) or a donor (allograft). Common grafts include the plantaris or hamstring tendons.

Tenodesis

When the tear is near the tendon’s bone attachment or the tendon has moved a lot, tenodesis might be chosen. This involves attaching the tendon to the bone for extra stability.

After surgical repair, patients need to rest and then start physical therapy. This helps them regain strength, flexibility, and function. Recovery times vary, but most people can get back to normal activities in a few months.

Recovery and Rehabilitation

After treating a peroneal tendon tear, a detailed recovery plan is key. It helps regain strength, flexibility, and stability in the ankle. This lets patients slowly get back to their daily life and sports.

Physical therapy is vital in this recovery. A skilled therapist creates a plan just for the patient. First, they focus on reducing pain and swelling in the ankle. This is done with ice, compression, and elevation.

As healing goes on, the therapy program gets more advanced. It includes exercises to improve ankle movement, strengthen the tendons and muscles, and boost body awareness. Some exercises might be:

• Ankle circles and alphabet tracing
• Resistance band exercises for the peroneal tendons
• Calf raises and heel walks
• Balance and stability exercises on various surfaces

Patients also get a home exercise program to keep up the good work between sessions. Sticking to the plan is key for a full recovery and avoiding future injuries.

The time needed for recovery and therapy varies. It depends on the tear’s severity and the treatment type. Non-surgical cases might take weeks to months of therapy. Surgical cases could need even longer. Regular check-ups with the doctor and therapist are important. They help make sure the treatment is working right.

Preventing Peroneal Tendon Tears

It’s important to prevent peroneal tendon tears to keep your ankles healthy. This helps avoid the pain and limitations that come with such injuries. Here are some ways to lower your risk:

Proper Footwear

Choosing the right shoes is key to protecting your peroneal tendons. Look for shoes that offer good support, stability, and cushioning. Here are some things to consider:

Ankle Strengthening Exercises

Doing exercises that strengthen your ankles can help keep your peroneal tendons safe. Some good exercises include:

• Calf raises
• Ankle circles
• Resistance band exercises
• Single-leg balance training

Do these exercises often to build strength and lower injury risk.

Gradual Return to Activity

If you’ve had a peroneal tendon tear or any ankle injury, give your ankle time to heal. Rushing back to sports or hard exercises can lead to more injuries or chronic pain. Here’s what to do:

• Follow your doctor’s or physical therapist’s advice on rest and rehab
• Start with low-impact activities and slowly increase the intensity and time
• Stop if you feel pain or discomfort
• Keep stretching and strengthening to keep your ankle flexible and stable

By wearing the right shoes, doing ankle exercises, and slowly getting back into activities, you can lower your risk of peroneal tendon tears. This helps keep your ankles healthy and pain-free.

When to Seek Medical Attention

If you have ongoing foot pain or think you might have hurt your ankle, get help right away. Not treating a possible peroneal tendon tear can make things worse. Look for swelling, tenderness, or weakness on the outside of your ankle or foot.

For serious ankle injuries, like a tendon rupture, see a doctor fast. You might hear a popping sound, feel a lot of pain, and find it hard to walk. Waiting too long to treat a torn tendon can cause ongoing problems and make your ankle unstable.

Getting medical help quickly helps you get the right treatment. Your doctor will figure out how bad the injury is and what to do next. This could be rest, using a cast, physical therapy, or surgery. Early treatment helps avoid long-term issues and gets you back to normal faster.