What is a peroneal tendon tear?

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A peroneal tendon tear is an injury that affects one or both of your peroneal tendons in your foot. You have two peroneal tendons (peroneal brevis and peroneal longus). These strong bands of tissue connect muscles in your lower leg to bones in your foot and help stabilize your foot and ankle. They extend along your outer ankle bone and the side of your foot.

With a torn peroneal tendon, you feel pain along the outside of your ankle. Your foot may feel unstable or unsteady when walking. You may notice symptoms after a sudden injury to your foot or ankle (like a sharp roll of your ankle). Symptoms may develop gradually due to long-term stress on your tendon.

Peroneal tendon tears often occur along with other ankle injuries like ankle sprains. For example, rolling or twisting your ankle could lead to a sprained ankle most often but also could be a torn peroneal tendon. Both injuries cause ankle pain, but you might think the pain is only from the sprain. So, peroneal tendon tears often hide behind other injuries and can be tricky to diagnose.

Types of peroneal tendon tears

Peroneal tendon tears can be either acute or chronic. Acute tears are generally from a traumatic injury that causes an acute tear. For example, rolling your ankle inward (inversion injury) can force your peroneal tendon to quickly bring your foot back into alignment. This action may cause your tendon to overcompensate and stretch too far, leading to a tear.

Usually, with an acute tear, you can pinpoint the moment it happened.

Chronic tears are more commonplace. You might not remember rolling or hurting your ankle.

These injuries happen slowly, over time, due to gradual stress and pressure on your tendon.

Pain around your ankle may come and go, and you might not know what’s causing it.

What causes a peroneal tendon tear?

Causes of a peroneal tendon tear include sudden trauma to your ankle, such as an inversion ankle sprain (rolling your ankle inward). Other causes include chronic stress and pressure on your tendon from overuse.

What are the risk factors?

Factors that can raise your risk of a peroneal tendon tear include playing sports that involve repetitive, side-to-side ankle movements (like basketball). Having high arched feet can cause stress on the lateral tendons. Other causes are having tight muscles in your lower legs/calves, Inappropriate footwear and poor training form.

Without treatment, this injury can lead to repeated ankle sprains. Other complications include continued ankle/foot pain, ongoing ankle instability and tendon snapping or subluxation over the outer ankle bone.

How are peroneal tendon tears diagnosed?

Diagnosis begins with a physical exam. During an exam, a healthcare provider will first obtain a history. After the history is obtained the clinician will examine your foot and ankle for signs of injury and order imaging tests as needed.

Testing for this condition includes x-rays of the foot and ankle. If necessary, ultrasound and MRI may need to be ordered.

How do you treat a torn peroneal tendon?

Healthcare providers treat a torn peroneal tendon with conservative (nonsurgical) measures, surgery or both. If your tear is mild, your provider may suggest conservative measures for several months to see if they help. If your tear is severe, your provider will likely suggest surgery as the first-line treatment.

Conservative measures include anti-inflammatory medications. Differing levels of immobilization corresponding with the severity of the tear would be instituted. Physical therapy is important to strengthen the tendon and surrounding areas.

If these methods don’t help, or if your tear is severe, you likely need surgery. Surgeons use many different techniques to restore function to your peroneal tendon. Your surgeon will choose the best technique for you based on the severity of the tear (partial or complete).

Possible surgical techniques include removing the damaged part of your tendon and repairing what’s left. Removing the damaged part of one peroneal tendon and sewing the remaining part to the other peroneal tendon (healthcare providers call this method a side-to-side tenodesis). Transferring a tendon from elsewhere in your foot to take over the function of your peroneal tendon. Using tissue from a donor (allograft) to reconstruct your peroneal tendon.

To make an appointment or for more information, call Weiss Foot and Ankle Center at (609) 561-2488 or go to weissfootandankle.com. David Weiss, DPM, is the owner of Weiss Foot & Ankle Center located at 777 South White Horse Pike, Suite D1 in Hammonton.