Peroneal Tendinitis

BACKGROUND

The peroneal tendons run on the outside of the ankle just behind the bone called the fibula. The first is called the Peroneus Brevis (PB). The term “brevis” implies short. It is called this because it has a shorter muscle and starts lower in the leg. The Peroneus Longus (PL) takes its name because it has a longer course. It starts higher on the leg and runs all the way underneath the foot to insert or connect on the first metatarsal on the other side. Both tendons, however, share the major job of everting or turning the ankle to the outside.PERONEAL TENDINITIS

Etiology

  • Repetitive or prolonged use
  • Increased training intensity
  • Altered vascularity (at high pressure points)

Dysvascular Zones

The peroneal tendons are susceptible to injury at certain specific points in its course where it has a tenuous blood supply.These sites are

  • Behind Fibula (PB)
  • At the Peroneal Tubercle(PL)
  • Undersurface of the Cuboid bone(PL)

Symptoms

✔ Thickening & tenderness along PL & PB.
✔ Pain at with heel rise
✔ Near normal strength unless frank rupture)
✔ Prominent Peroneal Tubercle
✔ Sural nerve dysesthesia

Differential Diagnosis

There may be a few causes for lateral foot & ankle pain. So it is important to exclude these conditions before arriving at a diagnosis of peroneal tendinitis. These are-

  • Subtalar arthritis
  • Lateral talar process fracture
  • Lateral ligament injury
  • Distal fibula avulsion fracture
  • Peroneal tendinitis

IMAGING MODALITIES

MRI SCAN
  • Modality of choice for assessment of the peroneal tendons.
  • PB tendon tears showed 83% sensitivity and 75% specificity as compared to intraoperative findings.
  • MRI may underestimate the extent of pathology, predominantly with regard to tears of the PL tendon.
Ultrasound Scan
  • Relatively Inexpensive.
  • Specificity is 85% – 90% and sensitivity is 100% in detecting tears.
  • Dynamic study.

One of its major limitations is that it is operator dependent.

TREATMENT OPTIONS

Conservative Options
  • NSAIDS
  • Rest & activity modification
  • Lateral heel wedges

Conservative Modalities Are Usually Successful In Treating Peroneal Tendinitis.

Surgical Options

Usually in refractory cases of peroneal tendinitis.

Synovectomy

  • Open synovectomy
  • Tenoscopy/tendinoscopy

paroneal-tendoscopyPERONEAL TENOSCOPY

PERONEUS LONGUS IN TENOSCOPYPERONEUS LONGUS IN TENOSCOPY