eMedicine Specialties > Sports Medicine > Lower Limb

Peroneal Tendon Syndromes: Follow-up

Author: Steven Karageanes, DO, Director, Primary Care Sports Medicine Fellowship, Director, Sports Medicine Education, Center for Orthopedics and Neuroscience; Department of Medical Education, Oakwood Healthcare System
Coauthor(s): Kathleen Sharp, MD, Sports Medicine Fellow, Department of Family Practice, Henry Ford Hospital
Contributor Information and Disclosures

Updated: Sep 2, 2008

Follow-up

Return to Play

If surgery and/or casting is not required for a peroneal tendon injury, the patient can usually return to activity in 1-2 weeks with ankle bracing or taping until strength and function are back to 90-100% of the nonaffected ankle.

If surgery is performed, return to play with bracing or taping is usually allowed once the strength and function of the ankle has been rehabilitated to 90% of that in the nonaffected ankle. Once the ankle is close to 100%, the bracing/taping is usually not necessary but permitted.

In most sports injuries, return to play should be allowed when the ankle has a painless range of motion, normal or improved balance, preinjury muscle strength, and no pain with sport-specific functional testing.

Related Medscape topic:
Resource Center Exercise and Sports Medicine

Complications

Complications of conservative treatment of a peroneal tendon injury are progression of pain and instability, and possible peroneal tendon rupture. Surgical complications vary depending on the procedure. A few common ones include sural nerve injury, progression of symptoms, chronic lateral ankle pain, and loss of range of motion. Any surgery poses a risk of infection and failure of the intent of the procedure.

Prevention

Several measures can be taken to prevent peroneal tendon injuries: (1) Good preexercise and postexercise stretching of the ankle, (2) a gradual increase in the level of activity or training, and (3) full rehabilitation of the ankle after any type of injury. These measures decrease the occurrence of ankle injury and, in turn, prevent peroneal tendon injury. Other interventions, such as attempting to correct foot abnormalities (eg, pes planus), also play an integral part in prevention.

Prognosis

The prognosis for improvement with conservative treatment is excellent if there is no functional instability requiring surgery. Surgical repairs for acute dislocation and chronic tears are also good. Casting for an acute dislocation has a success rate of only 50%. Therefore, this option should be reserved for patients with contraindications to surgery.

Education

Educating patients about the importance of ankle rehabilitation after an injury is the cornerstone in the prevention of peroneal tendon injuries. Further, stressing the need to stretch before and after exercise is also important.

Miscellaneous

Medicolegal Pitfalls

  • Missed fracture, especially lateral malleolar and calcaneal fractures
  • Injecting corticosteroids, which has a risk of fat necrosis and sural nerve damage
  • Using a cast to treat an acute dislocation of the tendon when surgery is not contraindicated

Related Medscape topics:
Resource Center Medical Malpractice and Legal Issues
Resource Center Trauma
Specialty Site Orthopaedics
Specialty Site Surgery

Special Concerns

  • Patients who have an unsteady gait, such as geriatric patients or patients with an acute injury to the ankle itself, may have difficulty ambulating.
    • Elderly patients are of particular concern because of the increased morbidity and mortality with falls and accidents in the home.
    • Ensure the patient has a stable gait when treating the ambulatory ankle injury. If the gait is not stable, make sure the patient has a 4-pronged cane, walker, or even a wheelchair.
  • A subluxed or torn peroneal tendon has low morbidity, but a fat embolus from a hip or femur fracture caused by a fall could be deadly.
 


More on Peroneal Tendon Syndromes

Overview: Peroneal Tendon Syndromes
Differential Diagnoses & Workup: Peroneal Tendon Syndromes
Treatment & Medication: Peroneal Tendon Syndromes
Follow-up: Peroneal Tendon Syndromes
Multimedia: Peroneal Tendon Syndromes
References
[ CLOSE WINDOW ]

References

  1. Fallat L, Grimm DJ, Saracco JA. Sprained ankle syndrome: prevalence and analysis of 639 acute injuries. J Foot Ankle Surg. Jul-Aug 1998;37(4):280-5. [Medline].

  2. Heckman DS, Reddy S, Pedowitz D, Wapner KL, Parekh SG. Operative treatment for peroneal tendon disorders. J Bone Joint Surg Am. Feb 2008;90(2):404-18. [Medline]. [Full Text].

  3. Rosenfeld P. Acute and chronic peroneal tendon dislocations. Foot Ankle Clin. Dec 2007;12(4):643-57, vii. [Medline].

  4. van Dijk CN, Kort N. Tendoscopy of the peroneal tendons. Arthroscopy. Jul-Aug 1998;14(5):471-8. [Medline].

  5. Slater HK. Acute peroneal tendon tears. Foot Ankle Clin. Dec 2007;12(4):659-74, vii. [Medline].

  6. Major NM, Helms CA, Fritz RC, Speer KP. The MR imaging appearance of longitudinal split tears of the peroneus brevis tendon. Foot Ankle Int. Jun 2000;21(6):514-9. [Medline].

  7. Diaz GC, van Holsbeeck M, Jacobson JA. Longitudinal split of the peroneus longus and peroneus brevis tendons with disruption of the superior peroneal retinaculum. J Ultrasound Med. Aug 1998;17(8):525-9. [Medline].

  8. Sammarco GJ. Peroneal tendon injuries. Orthop Clin North Am. Jan 1994;25(1):135-45. [Medline].

  9. Sobel M, Geppert MJ, Warren RF. Chronic ankle instability as a cause of peroneal tendon injury. Clin Orthop Relat Res. Nov 1993;296:187-91. [Medline].

  10. Raikin SM, Elias I, Nazarian LN. Intrasheath subluxation of the peroneal tendons. J Bone Joint Surg Am. May 2008;90(5):992-9. [Medline].

  11. Neustadter J, Raikin SM, Nazarian LN. Dynamic sonographic evaluation of peroneal tendon subluxation. AJR Am J Roentgenol. Oct 2004;183(4):985-8. [Medline]. [Full Text].

  12. Mendicino RW, Orsini RC, Whitman SE, Catanzariti AR. Fibular groove deepening for recurrent peroneal subluxation. J Foot Ankle Surg. Jul-Aug 2001;40(4):252-63. [Medline].

  13. Schweitzer ME, Eid ME, Deely D, Wapner K, Hecht P. Using MR imaging to differentiate peroneal splits from other peroneal disorders. AJR Am J Roentgenol. Jan 1997;168(1):129-33. [Medline]. [Full Text].

  14. DiGiovanni BF, Fraga CJ, Cohen BE, Shereff MJ. Associated injuries found in chronic lateral ankle instability. Foot Ankle Int. Oct 2000;21(10):809-15. [Medline].

  15. Karageanes SJ. Principles of Manual Sports Medicine. Philadelphia, Pa: Lippincott Williams & Wilkins; 2005.

  16. Kijowski R, De Smet A, Mukharjee R. Magnetic resonance imaging findings in patients with peroneal tendinopathy and peroneal tenosynovitis. Skeletal Radiol. Feb 2007;36(2):105-14. [Medline].

  17. Campbell SE, Warner M. MR imaging of ankle inversion injuries. Magn Reson Imaging Clin N Am. Feb 2008;16(1):1-18, v. [Medline].

  18. Waitches GM, Rockett M, Brage M, Sudakoff G. Ultrasonographic-surgical correlation of ankle tendon tears. J Ultrasound Med. Apr 1998;17(4):249-56. [Medline].

  19. Ho RT, Smith D, Escobedo E. Peroneal tendon dislocation: CT diagnosis and clinical importance. AJR Am J Roentgenol. Nov 2001;177(5):1193. [Medline]. [Full Text].

  20. Squires N, Myerson MS, Gamba C. Surgical treatment of peroneal tendon tears. Foot Ankle Clin. Dec 2007;12(4):675-95, vii. [Medline].

  21. Omey ML, Micheli LJ. Foot and ankle problems in the young athlete. Med Sci Sports Exerc. Jul 1999;31(7 suppl):S470-86. [Medline].

  22. Safran MR, O'Malley D Jr, Fu FH. Peroneal tendon subluxation in athletes: new exam technique, case reports, and review. Med Sci Sports Exerc. Jul 1999;31(7 suppl):S487-92. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

peroneal tendon syndromes, peroneal tendon, ankle sprain, ankle instability, peroneal tendonitis, peroneal tendinitis, peroneal tendon tears, peroneal tendon subluxation, peroneal tendon dislocation, peroneal tendon strain, peroneal tenosynovitis, peroneal retinaculum tear, peroneal tendon pathology, peroneus brevis disorders, disruptions of the peroneus longus, disruptions of the peroneus brevis, fractured os peroneum, fragmented os peroneum, longitudinal tears of the peroneus longus, peroneus brevis tears, longitudinal tears of the peroneus brevis tendon,  primary peroneus longus tendinopathy, peroneus longus rupture, ankle pain, foot pain, tendon rupture, lateral ankle ligament tear, inversion injury

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Steven Karageanes, DO, Director, Primary Care Sports Medicine Fellowship, Director, Sports Medicine Education, Center for Orthopedics and Neuroscience; Department of Medical Education, Oakwood Healthcare System
Steven Karageanes, DO is a member of the following medical societies: American Medical Association, American Osteopathic Association, and Michigan State Medical Society
Disclosure: Nothing to disclose.

Coauthor(s)

Kathleen Sharp, MD, Sports Medicine Fellow, Department of Family Practice, Henry Ford Hospital
Kathleen Sharp, MD is a member of the following medical societies: American Academy of Family Physicians and National Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Gerard A Malanga, MD, Founder and Director, New Jersey Sports Medicine Institute; Director of Pain Management, Overlook Hospital; Director of Sports Medicine, Sports Medicine Fellowship Director, Mountainside Hospital; Clinical Chief, Rehabilitation Medicine and Electrodiagnosis, St Michael's Medical Center; Medical Director, Consultant, Horizon Healthcare Worker's Compensation Services, Blue Cross and Blue Shield Worker's Compensation
Gerard A Malanga, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, North American Spine Society, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Russell D White, MD, Professor of Medicine, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center Lakewood
Disclosure: Nothing to disclose.

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD, Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago
Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.