Peroneal Tendon Tear Causes, Symptoms & Treatment Options

Overview

The peroneal tendons are strong, fibrous structures that connect the peroneal muscles of the lower leg to the bones of the foot and ankle. Two tendons – Peroneus longus and Peroneus brevis, pass posterior to the lateral malleolus, providing dynamic stabilization to the lateral ankle complex.

These tendons are essential for maintaining ankle stability during lateral movements, directional changes, and push-off activities.

Repetitive mechanical loading or acute traumatic events can cause tendinopathy, partial tears, or complete rupture of the peroneal tendons.

What causes Peroneal Tendon Tear?

Peroneal tendon tears and tendinopathy frequently occur in athletes participating in sports that involve running, jumping, and rapid changes in direction.

• How the Injury Occurs: Acute tears can result from sudden twisting or lateral ankle sprains. In contrast, chronic overuse from running on uneven surfaces or persistent ankle instability can lead to tendinopathy.
• Common Everyday Causes: Can develop from frequent walking or running on uneven terrain, wearing unsupportive footwear, or repetitive ankle movements during daily activities.

Peroneal tendon injuries are most commonly observed in the following sports:

• Soccer: Rapid changes in direction can place significant stress on the peroneal tendons.
• Football: Frequent cutting maneuvers and lateral movements increase ankle strain.
• Basketball: Jumping, pivoting, and quick lateral movements elevate the risk of tendon injury.
• Running: Repetitive motion on uneven surfaces can lead to overuse tears.
• Dancing: Repeated foot flexion and ankle rotation place strain on the tendons.
• Volleyball: Frequent jumping and landing challenge tendon stability.
• Tennis: Lateral sprints and abrupt stops can overload the peroneal tendons.

Symptoms

Peroneal tendinopathy typically causes burning or aching pain along the lateral aspect of the foot, ankle, and lower leg. The pain usually worsens with activity and improves with rest. Peroneal tendon tears may present similar symptoms, but athletes can also experience sharp or tearing pain during movement.

Common clinical features include:

• Lateral ankle pain: Patients often experience persistent discomfort along the outer side of the ankle, which intensifies with activity.
• Pain with specific movements: Pain increases when the foot is inverted or everted, indicating tendon involvement.
• Localized swelling: Swelling is often present around the lateral malleolus.
• Tenderness and warmth: The affected tendon may feel tender to the touch and appear warm, reflecting inflammation.
• Weakness or instability: The patient may have reduced foot strength and compromised push-off, which can affect balance and athletic performance.

Non-operative treatment

Mild to moderate cases of peroneal tendonitis are typically managed with conservative care. Treatment begins with rest and temporary avoidance of activities that aggravate ankle pain. Athletes should discuss activity modification with their physician, such as running on level surfaces or substituting low-impact exercises like swimming.

• Immobilization: A cast or splint may be used to restrict tendon motion and facilitate healing.
• Ice therapy: Apply ice for 20 minutes every two to three hours to reduce pain and inflammation.
• Elevation: Keeping the ankle elevated helps limit swelling and promotes venous return.
• Compression: An elastic bandage or ankle wrap can provide support and control edema.
• Taping or bracing: Stabilizes the ankle and reduces mechanical strain on the tendon.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): Medications such as ibuprofen or naproxen help relieve pain and decrease inflammation.
• Physical therapy: Structured exercises are prescribed to restore strength, flexibility, and tendon function.
• Corticosteroid injections: In select cases, injections may be administered to reduce inflammation and manage persistent pain.

Start these recovery exercises to help strengthen your ankle and prevent re-injury.

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Peroneal Tendon Tear

Surgical Treatment

In more severe cases, such as partial or complete peroneal tendon tears, surgical intervention may be required to restore tendon integrity and function. The procedure typically involves repairing the damaged tendon and addressing any associated structural abnormalities identified during evaluation.

Your surgeon will determine the most appropriate surgical approach based on the extent of injury and individual functional needs.