Peroneal Tendon Repair
The peroneal tendons are located along the outer edge of the lower leg, and are contained in a fibrous tunnel that runs behind the outside of the ankle bone. These tendons provide stability and function to the ankle joint. Injuries to the peroneal tendons are typically due to repetitive strain on the ankle.
Peroneal tears may be caused by long-term overuse or trauma, and can either occur suddenly or develop over time. These tears are usually characterized by pain, swelling and weakness or instability of the ankle. Peroneal tendon dislocations, also known as subluxation, occur when the tissue holding the tendon in place becomes torn either by injuring or spraining the ankle. The treatment of peroneal tendon injuries may be surgical or non-surgical.
Causes of Peroneal Tendon Tear or Dislocation
Peroneal tendon injuries usually develop in individuals who participate in sports that require constant movement of the ankles, such as running, baseball, soccer and gymnastics. Peroneal tendon tears occur when the retinaculum, the tissue band that surrounds tendons and keeps them in place, becomes weakened or torn. Peroneal tendon dislocations occur when the retinaculum has become so damaged that the tendons cannot be held in place at all. Peroneal tendon dislocations commonly follow an ankle sprain.
The symptoms associated with a peroneal tendon tear or dislocation include:
- Ankle pain
- Recurrent popping sensations at the outer edge of the ankle
- Tenderness around the outside of the ankle
- Weakness or instability of the ankle or foot
Diagnosis of Peroneal Tendon Tear or Dislocation
In some cases, peroneal tendon injuries may be misdiagnosed. In order to accurately diagnose a peroneal tear or dislocation, imaging tests such as an X-ray or MRI scan may be conducted to evaluate the injury. A physical examination of the foot is also performed to assess the extent of pain, instability, swelling and weakness.
Nonsurgical Treatment of Peroneal Tendon Tear or Dislocation
Conservative treatments can help improve the function and strength of a person’s ankle, and may include nonsteroidal anti-inflammatory medications, physical therapy and immobilizing the ankle with a splint, brace or cast. Patients who have experienced a peroneal tendon dislocation, or peroneal tendon tears that at are unresponsive to nonsurgical treatments, may require surgery to either repair or reconstruct the tendon.
Surgical Repair of Peroneal Tendon Tear or Dislocation
Peroneal tendon tears or dislocations may require surgical repair or restoration of the tendon. Two surgical options for peroneal tendon tear or dislocation repair include retinaculum repair and groove reconstruction.
Retinaculum repair is a procedure focused on repairing the retinaculum, which are the bands of tissue that surround and stabilize the peroneal tendons. During this surgery, an incision is made near the back and lower edge of the fibula, or calf, bone, so that the retinaculum tear can be clearly seen. An opening is then created along the fibula, next to the original attachment of the retinaculum. The torn area of the retinaculum is pulled into the opening and sutured firmly in place.
Groove reconstruction is a procedure performed to keep the peroneal tendons in place behind the bottom of the fibula. In this surgery, an incision is made near the back and lower edge of the fibula bone. A small flap is created toward the bottom of the fibula and then carefully folded back, similar to a hinge attachment. The hinge attachment is held open, while a small amount of bone under the flap is removed to deepen the groove and the bottom of the fibula. Finally, the tendons are moved behind the fibula, and the incision is sutured closed. Groove reconstruction is occasionally performed in combination with retinaculum repair.
Recovery from Peroneal Tendon Tear or Dislocation Repair
Following surgery, patients typically are in a cast for two weeks, then walking boot for another 4-6 weeks. Physical therapy is required for optimal recovery.