Understanding Peroneal Tendons Pain, Causes, and Treatments

One cause of continued pain around the ankle region that may occur either after a traumatic injury of the ankle (such as an ankle sprain) or without any specific injury that can be recalled are disorders of the peroneal tendons.

Peroneal tendons are two tendons that run on the outside part of the ankle behind the outside ankle bone (lateral malleolus) and extend from the outside part of the ankle down to the outside part of the foot. These tendons run in a tunnel-like sheath that hold the tendons in place.

At times the tendon sheath may become torn causing the tendons to pop out of their normal position behind the ankle. A peroneal tendon tear causes abnormal rubbing on the lateral ankle bone (fibula), which is a condition called peroneal tendon subluxation. The tendons may also tear due to the abnormal rubbing on the bone. Alternatively, the tendon may tear without an abnormality of the tendon sheath. These Peroneal tendon tears generally do not resolve with conservative treatment and surgery is often necessary.

Surgery For Peroneal Tendon Tears

Surgical treatment is indicated when pain is persistent and involves repairing the existing tendon whenever possible. In scenarios where the tendon is not repairable, the surgical procedure includes transferring the tendons and suturing them together. The goal in both approaches is to maintain functionality and overall balance of the foot.

Patients may also experience a torn tendon sheath, which allows the tendons to move from their appropriate positions. A surgical repair of lining, sometimes with a trough created in the fibula bone, recreates a normal tunnel for the tendons. The time frame for recovery is variable depending upon which of the above procedures is necessary, but the standard recovery plan is two weeks of non-weight-bearing in a cast followed by six weeks of weight-bearing in a boot. Return to sport is also dependent upon the type of injury and treatment, and may be in as little as three months; however, in some cases, a longer recovery can be expected.

Peroneal Tendoscopy: A Minimally Invasive Alternative

An additional treatment that is beneficial for some patients is peroneal tendoscopy. This minimally-invasive procedure is utilized to examine the peroneal tendons by way of two small poke hole incisions in the skin. A camera and probe in the tendon tunnel examines the tendons thoroughly, which can help diagnose a suspected tendon tear which MRI or ultrasound testing have been unable to confirm. If a tear is identified, then a limited open incision over the area of the tear can be performed to repair the tendon in the methods described above. If no tear is present, open surgery is not performed in order to minimize potential complications. Scar tissue in the tendon sheath can be cleaned out through the camera alone if necessary. Dr. Vora specializes in this minimally-invasive technique for the treatment of this condition when appropriate.

For more on this condition, also see:
Arthroscopy of the foot and ankle

Consult With an Orthopedic Foot & Ankle Specialist Near Chicago

Dr. Anand Vora is a highly regarded foot and ankle specialist affiliated with the Illinois Bone & Joint Institute. If you are interested in making an appointment with Dr. Vora, please fill out the contact form to the right or call 847-247-4000 to speak to his staff. Dr. Vora has offices in both Chicago, IL and Libertyville, IL.