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Peroneal Tendon Syndromes Follow-up

  • Author: Steven J Karageanes, DO, FAOASM; Chief Editor: Craig C Young, MD  more...
Updated: Jun 25, 2015

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.



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.



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.



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.

A study reviewed the long-term clinical and patient-reported outcomes of a cohort of patients with peroneal tendon tears treated with debridement and primary repair. The study of 18 patients with an average follow-up of 6.5 years found excellent long-term functional outcomes for patients with tears of the peroneal tendons treated with debridement and primary operative repair. The study also observed that the majority of patients returned to their previous level of activity without the need for reoperation or revision of the repair.[30]



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.

Contributor Information and Disclosures

Steven J Karageanes, DO, FAOASM Director of Sports Medicine, St Mary Mercy Hospital Livonia; Regional Assistant Dean, Kansas City University of Medicine and Biosciences; Clinical Assistant Professor, Michigan State University College of Osteopathic Medicine

Steven J Karageanes, DO, FAOASM is a member of the following medical societies: American Medical Association, American Osteopathic Academy of Sports Medicine, American Osteopathic Association, Michigan State Medical Society

Disclosure: Nothing to disclose.


Kathleen Sharp, MD, CAQSM Staff Physician, Parkland Homes Program

Kathleen Sharp, MD, CAQSM is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, National Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Russell D White, MD Clinical Professor of Medicine, Clinical Professor of Orthopedic Surgery, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center-Lakewood

Russell D White, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Family Physicians, American Association of Clinical Endocrinologists, American College of Sports Medicine, American Diabetes Association, American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa

Disclosure: Nothing to disclose.

Additional Contributors

Gerard A Malanga, MD Founder and Partner, New Jersey Sports Medicine, LLC and New Jersey Regenerative Institute; Director of Research, Atlantic Health; Clinical Professor, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey-New Jersey Medical School; Fellow, American College of Sports Medicine

Gerard A Malanga, MD is a member of the following medical societies: Alpha Omega Alpha, American Institute of Ultrasound in Medicine, North American Spine Society, International Spine Intervention Society, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine

Disclosure: Received honoraria from Cephalon for speaking and teaching; Received honoraria from Endo for speaking and teaching; Received honoraria from Genzyme for speaking and teaching; Received honoraria from Prostakan for speaking and teaching; Received consulting fee from Pfizer for speaking and teaching.

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Lateral ankle anatomy demonstrates the peroneal tendons as they course beneath the superior retinaculum. The anterior talofibular, calcaneofibular, and posterior talofibular ligaments are also shown.
Anterior drawer test, which assesses anterior talofibular ligament stability. The top hand stabilizes, while the lower hand translates the calcaneus and talus directly toward the operator. From Karageanes SJ. Principles of Manual Sports Medicine, Lippincott Williams & Wilkins, 2005.
Tilt test. The operator tilts the talus and calcaneus, not the forefoot. This assesses the integrity of the calcaneofibular ligament. From Karageanes SJ. Principles of Manual Sports Medicine, Lippincott Williams & Wilkins, 2005.
Dislocated peroneal tendons. Left, Note the course of the tendons anterior to the lateral malleolus. Right, Image demonstrates manual relocation of the displaced tendons.
Peroneal stability test. The patient pushes the foot laterally against resistance, while the operator monitors the tendon. From Karageanes SJ. Principles of Manual Sports Medicine, Lippincott Williams & Wilkins, 2005.
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