Peroneal Tendon injury - What is it?
The Peroneal muscel group is made up of 3 main muscles the Brevis the longus and the tertius
Injury to the Peroneal is usually either a strain or a tear, however it can also be injured from overuse.
Enclosed within the lateral compartment of the leg, the peroneal tendons are the primary evertors of the foot and function as lateral ankle stabilisers.
Pathology of the tendons falls into three broad categories: tendinitis and tenosynovitis, tendon subluxation and dislocation, and tendon splits and tears
GOLD STANDARD TREATMENT FOR PERONEAL TENDINOPATHY
LEG- GOLD STANDARD TREATMENT PROTOCLS FOR PEREONAL TENDON ISSUES
The Lower Extremity Group offers to you the Gold Standard in Lower extremity injury rehabilitation.
We utilise a
World Class rehabilitation program for Peroneal tendinopathy, and this is deilvered to you online in the comfort of your own home. All you have to do is follow our easy to use evidence based plan to treat and manage your Peroneal tendinopathy.
This online program contains 4 complete weeks of revolutionary rehabilitation guides to help you manage and treat your Peroneal tendinopathy issues every single day.
We deliver our evidence-based daily Achilles management program via our amazing app, which is very easy for you to follow and includes 28 days of;
Progressive neuromuscular exercises that will strengthen the muscles around the foot and ankle and help reduce the pain associated with Peroneal tendinopathy.
5 progressive levels of evidence based rehabilitation that do not require expensive equpiment
Passive and dynamic mobility exercises to increase range of motion and tissue extensibility of mucles and fascia
Myofascial massage exercises
We offer online consultations as a part of the rehabiliation precess to help you rehabilitate and manage your Peroneal tendinopathy.
Our experienced therapists have taken these aforementioned technical modalities and simplified them into easy to watch videos for you to follow and complete. These are delivered daily to your smart device within our Peroneal tendinopathy management program.
Book in today - Online or in clinic
Using the app will enable you to understand when to apply the various exercises to help manage Peroneal tendinopathy
RECOMMENDED MEDICAL LITERATURE HUB
Peroneal tendon disorders - Kinner Davda et al 2017
EFORT Open Rev. 2017 Jun 22;2(6):281-292. doi: 10.1302/2058-5241.2.160047. eCollection 2017 Jun.
Pathological abnormality of the peroneal tendons is an under-appreciated source of lateral hindfoot pain and dysfunction that can be difficult to distinguish from lateral ankle ligament injuries.Enclosed within the lateral compartment of the leg, the peroneal tendons are the primary evertors of the foot and function as lateral ankle stabilisers.Pathology of the tendons falls into three broad categories: tendinitis and tenosynovitis, tendon subluxation and dislocation, and tendon splits and tears. These can be associated with ankle instability, hindfoot deformity and anomalous anatomy such as a low lying peroneus brevis or peroneus quartus.A thorough clinical examination should include an assessment of foot type (cavus or planovalgus), palpation of the peronei in the retromalleolar groove on resisted ankle dorsiflexion and eversion as well as testing of lateral ankle ligaments.Imaging including radiographs, ultrasound and MRI will help determine the diagnosis. Treatment recommendations for these disorders are primarily based on case series and expert opinion.The aim of this review is to summarise the current understanding of the anatomy and diagnostic evaluation of the peroneal tendons, and to present both conservative and operative management options of peroneal tendon lesions.
Peroneal Tendon Disorders - Brent Roster et al
Clin Sports Med. 2015 Oct;34(4):625-41. doi: 10.1016/j.csm.2015.06.003. Epub 2015 Jul 31.
Peroneal tendon pathology is often found in patients complaining of lateral ankle pain and instability. Conditions encountered include tendinosis; tendinopathy; tenosynovitis; tears of the peroneus brevis, peroneus longus, and both tendons; subluxation and dislocation; and painful os peroneum syndrome. Injuries can be acute as a result of trauma or present as chronic problems, often in patients with predisposing structural components such as hindfoot varus, lateral ligamentous instability, an enlarged peroneal tubercle, and a symptomatic os peroneum. Treatment begins with nonoperative care, but when surgery is required, reported results and return to sport are in general very good.
Peroneal Tendinosis and Subluxation -J.G Lugo-Pico et al 2020
Clin Sports Med. 2020 Oct;39(4):845-858. doi: 10.1016/j.csm.2020.07.005. Epub 2020 Aug 14.
Peroneal tendinosis and subluxation are lifestyle-limiting conditions that can worsen if not properly diagnosed and treated. Adequate knowledge of ankle anatomy and detailed history and comprehensive physical examination is essential for diagnosis. Peroneal tendinopathy is likely to result from overuse, whereas subluxation often precipitates from forceful contraction of peroneals during sudden dorsiflexion while landing or abruptly stopping. In athletes, conservative measures remain first-line treatment of tendinopathy, but surgery is often immediately indicated in cases of recurrent symptomatic subluxation or dislocation. Surgical technique varies on the type, mechanism, and severity of injury, but most procedures have a high success rate.
Peroneal Tendon Pathology: Treatment and Reconstruction of Peroneal Tears and Instability - Bahad et al 2020
Orthop Clin North Am. 2020 Jan;51(1):121-130. doi: 10.1016/j.ocl.2019.09.001.
Peroneal tendon pathology is becoming an increasingly recognized source of lateral-sided ankle pain. High clinical suspicion, along with judicious physical examination coupled with confirmatory advanced imaging modalities, are necessary to make an accurate diagnosis and aid in guiding treatment.
Peroneal pathology encompasses several distinct conditions.
Peroneal tendon tears and injuries to the peroneal retinaculum must be identified to guide treatment.
Patients with peroneal pathology report high levels of satisfaction after surgical management with most returning to their preinjury level of function. An early and accurate diagnosis, along with treatment tailored to the individual, is necessary to obtain optimal outcomes.
Peroneal Sheath Volumes Are Greater in Patients With Peroneal Pathology Compared With Controls -
Miller et al 2020
Foot Ankle Spec. 2020 Aug 27;1938640020950897. doi: 10.1177/1938640020950897. Online ahead of print.
Background: Peroneal tendon pathology is common. Several factors have been implicated, including low-lying muscles and accessory tendons. Studies have reported on the presence and length measurements of these structures. This study evaluates volume measurements within the sheath using magnetic resonance images for patients with operatively treated peroneal tendon pathology and control patients without peroneal disease.
Methods: Fifty-one patients with peroneal tendon pathology and 15 controls were included. The volumes of the peroneal sheath, peroneal tendons, peroneal muscle, and accessory peroneus tendons were measured. The distal extent of the peroneus brevis (PB) muscle was measured. Volume and length measurements were then compared.
Results: The mean PB muscle length from the tip of the fibula was 5.55 ± 2.5 mm (peroneal group) and 11.79 ± 4.07 mm (control) (P = .017). The mean peroneal sheath volume was 7.06 versus 5.12 mL, respectively (P = .001). The major contributors to this increased volume was the tenosynovitis (3.58 vs 2.56 mL, respectively; P = .019), the peroneal tendons (2.17 vs 1.7 mL, P = .004), and the accessory peroneus tendon + PB muscle (1.31 vs 0.86 mL, P = .023).
Conclusion: The current study supports that the PB muscle belly is more distal in patients with peroneal tendon pathology. The study also demonstrates increased total volume within the peroneal sheath among the same patients. We propose that increased volume within the sheath, regardless of what structure is enlarged, is associated with peroneal tendon pathology. Further studies are needed to determine if debridement and decompression of the sheath will result in improved functional outcomes for these patients.