Peroneus Brevis and Peroneus Longus Tendon Problems
The peroneals are two muscles and their tendons that lie along the outside of the lower leg bone (the fibula) and cross behind the lateral malleolus (the outer ankle bone). The term medial refers to a point closer to the center of the body. So the ankle bump on the inside edge of the ankle (closest to your other ankle) is the medial malleolus. The term lateral refers to structures furthest from the center. Major muscles that support the lateral part of the ankle are the peroneus longus and the peroneus brevis.
Problems affecting the two peroneal tendons that lie behind the outer ankle bone (the lateral malleolus) are common in athletes. These problems mainly occur in the area where the two tendons glide within a fibrous tunnel behind the lateral malleolus.
Nonsurgical treatment for peroneal tendon problems helps control symptoms. Surgery is usually not considered until it has become impossible to control the symptoms without it.
Initial treatments may involve resting and protecting the sore tendons. You may need to immobilize your foot and lower leg in a a short-leg walking boot for two to four weeks. In less severe cases, you may use a stirrup ankle brace, arch support, or lateral heel wedge to take tension off the sore tendons.
You will probably work with a physical therapist. The therapist may use heat, ice, and ultrasound treatments to reduce pain and swelling. Stretching, strengthening, and ankle coordination exercises are added as symptoms ease.
Your doctor may also prescribe medications. Anti-inflammatory medications can help ease pain and swelling and get you back to activity sooner. These medications include common over-the-counter drugs such as ibuprofen.
In rare cases, cortisone can be injected into the sore tendons to relieve symptoms that won’t go away. Cortisone is a powerful anti-inflammatory medication. Because there is a risk that cortisone will cause a tendon to rupture, doctors are very cautious about injecting cortisone into the peroneal tendons.
When the lining of the tendon is painful and inflamed (as in tenosynovitis), the goal of surgery is to remove the irritated tissue from around the tendon. This operation is called tendon release. This procedure is done by carefully dividing the tendon sheath that encloses the tendon. Once the sheath is opened, the surgeon clears away the irritated tissues around the tendon. The sheath is not stitched back together. The gap in the sheath will eventually fill in with scar tissue. The skin is closed with sutures.
The procedure for surgically treating tendinosis is similar to the method used for tenosynovitis. However, extra measures are taken to thoroughly remove (debride) the degenerated tissue around and within the involved tendon.
Tendinosis may require repair if a preoneal tendon is split down its length. This type of tear mainly affects the peroneus brevis. The surgeon fixes this problem by first dividing the sheath around the tendons. If the split is smaller than one-third the width of the tendon, the torn portion may simply be removed. Larger splits are sutured along the length of the tendon. The tendon sheath is repaired, and the skin is closed with sutures.
What should I expect following treatment?
Even if you don’t need surgery, you may need to follow a program of rehabilitation exercises. Your doctor may recommend that you work with a physical therapist. Your therapist can create a program to help you regain normal ankle function. It is very important to improve strength and coordination in the ankle.
Patients are usually placed in a short-leg cast for four to six weeks after surgery. A special walking boot is worn for another four weeks. Patients usually take part in formal physical therapy once the cast is removed. Rehabilitation after surgery can be a slow process. You will probably need to attend therapy sessions for one to two months, and you should expect full recovery to take up to four months.
The first few physical therapy treatments are designed to help control pain and swelling from the surgery. Ice and electrical stimulation treatments may be used during your first few therapy sessions. Your therapist may also use massage and other hands-on treatments to ease muscle spasm and pain. Treatments are also used to help improve ankle range of motion without putting too much strain on the healing tendons.
After about four weeks you may start doing more active exercise. Exercises are added slowly to improve the strength in the peroneal muscles. Your therapist will also help you regain position sense in the ankle joint to improve its overall stability.
The physical therapist’s goal is to help you keep your pain under control, improve your range of motion, and maximize strength and control in your ankle. When you are well under way, regular visits to the therapist’s office will end. Your therapist will continue to be a resource, but you will be in charge of doing your exercises as part of an ongoing home program.