Diagnostic Considerations

Differential diagnoses for peroneal tendon pathology include the following:

Lateral ankle instability
Syndesmotic injuries
Osteochondritis of talus
Painful os trigonum
Lateral ankle and foot fractures (see Physical Examination)
Retrocalcaneal bursitis

Workup

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Media Gallery

Lateral view of ankle, with marking of distal fibula, base of fifth metatarsal, and intended incision.
Peroneus brevis degeneration forming ganglion-type mass.
Peroneus longus tendon next to peroneus brevis tendon.
Peroneus brevis above after resection of degenerative mass and peroneus longus below.
Partial repair of peroneal tendon sheath.
Repaired peroneal tendon sheath.
Skin closed over peroneal tendon repair.
Cystic mass (ganglion) on right arising from peroneal tendon (×40).
Ganglion with myxoid degeneration and connective tissue with myxoid material pools with cystic change (×400).
Appearance of normal peroneal tendons on MRI. Axial turbo spin-echo (TSE) T1-weighted image (left) shows peroneus brevis (short arrow). TSE proton density (PD)-weighted fat-suppressed (FS) image (center) shows peroneus longus (arrowhead). Sagittal TSE T2-weighted FS image (right) shows peroneus longus (arrowhead).
Turbo spin-echo (TSE) T1-weighted MRI shows hypointense peroneus quartus tendon (arrow) with muscle belly seen posterior to peroneus longus and peroneus brevis tendon.
Plain lateral radiograph (left) shows os peroneum. Axial CT (right) shows os peroneum adjacent to cuboid bone .
Axial turbo spin echo (TSE) T1-weighted and TSE T2-weighted fat-suppressed (FS) MRI shows split of peroneus brevis tendon into two subtendons.
Coronal short TI inversion recovery (STIR)-sequence MRI shows hyperintense calcaneofibular ligament at fibular attachment (left) and calcaneal attachment (right).
Ganglion arising from peroneal tendon sheath as cause of painful swelling. Left image shows palpable tender swelling behind lateral malleolus; center image shows ganglion as seen intraoperatively; right image is view after excision.

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Author

Rajesh Malhotra, MBBS, MS Professor and Head, Department of Orthopedics, All India Institute of Medical Sciences; Chief, JPN Apex Trauma Centre, India

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.

Chief Editor

Vinod K Panchbhavi, MD, FACS, FAOA, FABOS, FAAOS Professor of Orthopedic Surgery, Chief, Division of Foot and Ankle Surgery, Director, Foot and Ankle Fellowship Program, Department of Orthopedic Surgery, University of Texas Medical Branch School of Medicine

Vinod K Panchbhavi, MD, FACS, FAOA, FABOS, FAAOS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Orthopaedic Trauma Association, Texas Orthopaedic Association

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Styker.

Additional Contributors

James K DeOrio, MD Professor of Orthopedics, Director, Duke Foot and Ankle Fellowship, Duke University Medical Center, Duke University School of Medicine; Associate Professor, Mayo Clinic College of Medicine; Clinical Assistant Professor, F Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences

James K DeOrio, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Foot and Ankle Society, Association of Graduates, United States Air Force Academy, Doctors Mayo Society, Mayo Clinic Alumni Association, Society of Air Force Clinical Surgeons, Society of Military Orthopaedic Surgeons

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Exactech; Treace Medical; Additive; Mirus; Crossroads Orthopedics<br/>Serve(d) as a speaker or a member of a speakers bureau for: Exactech; Treace Medical; Additive; Mirus; WoultersKluwer; Crossroads Orthopedics<br/>Received income in an amount equal to or greater than $250 from: Exactech; Treace Medical; Additive; Mirus; WoultersKluwer; Crossroads Orthopedics.

Heidi M Stephens, MD, MBA Associate Professor, Department of Surgery, Division of Orthopedic Surgery, University of South Florida College of Medicine; Courtesy Joint Associate Professor, Department of Environmental and Occupational Health, University of South Florida College of Public Health

Heidi M Stephens, MD, MBA is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Medical Association, American Orthopaedic Foot and Ankle Society, Florida Medical Association

Disclosure: Nothing to disclose.

Peroneal Tendon Pathology Differential Diagnoses

Diagnostic Considerations

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