PERONEAL TENDON INJURIES
What are the peroneal tendons involved?
The peroneal brevis and longus tendons are found on the outer (lateral) aspect of the ankle behind the fibula. They are kept in place behind the fibula by a band of tissue (retinaculum) which acts like a sling allowing the tendons to glide and work efficiently. They are involved in helping the foot turn outwards. They are typically injured during a twisting-like injury (sprain) but can result from hypermobility of the joint. Patients with a high foot arch or coalition are at risk of these sprains. The injury can be a tear within one or both tendons or a tendon subluxation/dislocation from damage to the retinaculum.
Symptoms
Typically, there is pain around the injured area with swelling, which may be associated with instability when walking or running. If subluxation/dislocation of the tendon has occurred, patients often have a ‘queasy’ feeling when this recurs and can often demonstrate the abnormal tendon movement on demand.
Management
Initial management for all ankle sprains without a fracture should be protection of the joint (ankle brace or walking boot), rest (crutches), compression (sometimes a compression bandage is of help) and elevation. Analgesics and non-steroidal anti-inflammatory medication may also be used. Early functional physiotherapy will be instigated to help with the recovery.
The majority of ankle sprains settle with time following the above management, however if it does not then further investigation with magnetic resonance imaging (MRI) is considered.
With persistent pain and swelling surgical intervention can be considered. In this operation the unhealthy tendons are debrided
and repaired. If the retinaculum is damaged this may require reconstruction using suture anchors into the fibula bone. If subluxation/dislocation is the primary problem the groove at the back of the fibula is deepened to allow the tendons to lie better and prevent recurrence.
Recovery
If an isolated tendon debridement with repair is performed without disruption of the retinaculum, your leg will be heavily bandaged and placed in a walking boot to allow protected weightbearing for 2 weeks. After this 2-week period you can go back into comfortable shoes as tolerated and physiotherapy instigated. Elevation, above the heart level, as much as possible, is important.
For the other surgical options your leg will be placed in a below-knee cast for 2 weeks, and at this stage a wound check will be performed, and a complete below-knee cast applied for a further 4 weeks. For this initial 6 weeks no weight-bearing will be permitted, and crutches will be supplied for support. Elevation, above the heart level, as
much as possible, is important. After 6 weeks a walking boot will
be applied, and weight-bearing will be permitted in the boot and physiotherapy instigated.
Return to work can be expected at 6-8 weeks for jobs that are sedentary and 12-16 weeks for more manual and labour-intensive type jobs.
Return to driving will not be before 6 weeks and you must be able to perform an emergency stop. It is important to inform your insurance company of the type of procedure that has been undertaken to ensure the cover is valid.
Return to sports that are non-impact can be initiated at 6 weeks (training is allowed), however impact sporting activities are not permitted before 12 weeks
Risks of Surgery
As with any surgery there are potential risks. This will be discussed in more detail during the consultation, however common complications are stiffness, swelling, nerve injury, infection, recurrence of instability, and clots.