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Peroneal Tendons – Tenosynovitis and subluxation

Peroneal Tendons – Tenosynovitis and subluxation
Picture showing dislocation of the peroneal tendons including a peroneus quartius.

The peroneal tendons are positioned on the lateral (outer) side of the ankle. There are usually three tendons the longus, the brevis and the tertius. Some people have a 4th peroneal tendon, the quartius. This can be risk factor for subluxation or dislocation. Injuries to the peroneal tendons are common and can result in tendinitis, splits, subluxation or dislocation. Inversion injuries and lateral ankle sprains in sports such as rugby and football can lead to splits of the peroneus brevis. Eversion and dorsiflexion injuries in skiers in particular can result in subluxation or dislocation of the peroneal tendons. The peroneal tendons can be imaged accurately by ultrasound. Tendinitis and splits are often managed conservatively. Subluxation and dislocation often require surgery to stabilize the tendons.

Tenosynovitis usually occurs because of over use. Tenosynovitis may also occur as a result of a plantar flexion inversion injury to the ankle. This can be associated with a tendon tear or rupture. The peroneus longus usually compresses the brevis against the fibula causing a longitudinal split.

Subluxation or dislocation usually occur as a result of a specific traumatic event. The most common mechanism of injury being forced dorsiflexion. The peroneal tendons sublux anteriorly around the lateral edge of the fibula. Although conservative treatment with a period of immobilisation has yielded good results in at least 50% of patients, operative treatment is advocated in the young athlete. This usually consists of an anatomic repair of the superior peroneal retinaculum combined with a fibular groove deepening procedure.

We regularly treat patients with peroneal tendon disorders here at the A2F clinic.