There are 3 Peroneal Tendons on the outside of the ankle, Peroneal Brevis, Tertius, and Longus. Their main function is to provide stability to the foot and ankle through the gait cycle. Due to their anatomy, there is a compression site as they wrap around the head of the fibula bone that can lead to Peroneal tendon tears. The most common of these is a Peroneal Brevis Tendon Tear.
Peroneal Tendon Tear Symptoms
The peroneal tendons attach from the outer side of the fibula to the outer ankle and underside of the foot. There are two common sites of tears to these tendons. One is as they pass under the ankle bone leading to pain on the outer pain when walking or turning the foot outwards. The other less common site is on the outside of the foot as the tendon attaches onto the 5th metatarsal.
Pain is normally sudden in onset and with a larger tear, there may be an audible click or popping noise. This is often followed by bruising in the area and a burning type of pain. After the initial injury, symptoms are normally associated with movement and there is little to no pain at rest.
Degenerative tears occur most often in the Peroneal Brevis as it wraps under the fibula. Symptoms are slower in onset and mechanical and as a result, it is difficult to differentiate between a degenerative Peroneal Tendon Tear and Peroneal Tendonitis.
Peroneal Tendon Tear Causes
There are two common ways to develop a Peroneal Tendon Tear. The most common is a sudden tear through an acute movement of the ankle such as a lateral ankle sprain where the ankle suddenly turns inwards. This movement can overstretch the tendon causing a horizontal tear or less often a longitudinal split of the tendon.
Other causes are often biomechanical where compression of the tendon over time, particularly the Peroneal Brevis tendon as it gets wedged between the fibula head and the Peroneal Longus along with a poor blood supply can lead to a degenerative tear of the tendon.
Peroneal Tendon Tear Diagnosis
Peroneal Tendon Tears can be diagnosed in a clinic by a Physical Therapist. A clinical test involves the patient lying on their front with their knee flexed to 90º. The therapist resists the movement of the foot as the patient forcibly dorsiflexes and everts the foot. If this action reproduces pain in the peroneal tendon, it is a positive test.
An MRI is one of the most accurate forms of imaging used to diagnose Peroneal tendon tears. Another useful form of imaging alongside clinical testing is an ultrasound scan as it can give live imaging and it is cost-effective. An x-ray is not a useful tool to diagnose a Peroneal Tendon Tear although it may be useful to rule out other potential pathologies in the area.
Using these scans, a therapist can provide a diagnostic grading of a Peroneal Tendon tear. These are graded 1, 2, or 3 (high-grade tear) or it could indicate the less common longitudinal Peroneal tendon tear. This information is extremely beneficial as it has a direct implication on recovery times.
Peroneal Tendon Tear Treatment
Physical Therapy is the most effective form of treatment for a Peroneal Tendon tear. Following a clinical assessment of the biomechanics, mobility, and strength of the foot a graded strengthening exercise program is developed for the patient.
In the acute phase of injury (0-72 hours) rigid ankle taping can be beneficial to offload the Peroneal Tendons, therefore reducing inflammation and providing pain relief. A longer-term solution for reducing the irritability of symptoms is an ankle brace. KT Tape has been shown to have little to no benefit for these cases.
If pain levels remain too high to continue rehabilitation, a walking boot may be required for 1-2 weeks before recommencing strengthening exercises.
Injections for Peroneal Tendon tears are not recommended as they can decondition the tendon’s health while there is mixed evidence for the benefit of other injections such as PRP.
Surgery is often the last resort for non-resolving grade 1-2 tendon tears while a grade 3 rupture may be repaired by surgery. A longitudinal tear that is painful and unsuccessfully managed with conservative treatment often responds well to surgical repair. This is typically followed by a short period of time in a walker boot and Physical Therapy for 6-8 weeks.
Physiotherapy with James McCormack
This is not medical advice. We recommend a consultation with a medical professional such as James McCormack to achieve a diagnosis. He offers Online Physiotherapy Appointments for £45.
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