Peroneal Tendon Injuries

What are Peroneal Tendon Injuries?

Peroneal Tendon Injuries are tears in the peroneal tendon which can affect one or both of your peroneal tendons located in your foot. These tendons are strong bands of tissue that work to the connect the muscles in the lower leg to the bones in the foot and help stabilize the foot and ankle. On a diagram, you’d spot these tendons along the outer ankle bone and side of the foot.

Causes and Symptoms of Peroneal Tendon Injuries:

Peroneal Tendon Injuries stem from sudden trauma (such as rolling your ankle) or overuse of the tendon, and often occur with other ankle injuries like rolling, twisting, or spraining your ankle. Due to the nature of these injuries arising along with an ankle injury, they’re often overlooked and tricky to diagnose. It’s imperative to see a sports medicine physician or orthopaedist to have your injury accurately diagnosed and treated.

Symptoms of a Peroneal Tendon Injury can include:

• Pain along the outside of the ankle
• Pain that fluctuates
• A feeling of weakness or instability in the affected ankle
• Swelling in the affected ankle

Certain risk factors can increase the likelihood that you’ll develop a Peroneal Tendon Injury at some point in your life, including:

• Sports involving repetitive, side-to-side ankle movements, such as basketball or hockey
• High arches
• Tight muscles in the calves or lower legs
• Ill-fitting footwear or footwear not equipped for the activity at hand
• Poor form when training

Types of Peroneal Tendon Injuries:

There are a few different types of Peroneal Tendon Injuries that can occur ranging from acute to chronic. See below for more:

1. Acute Tears
   1. Acute tears stem from traumatic injury, such as rolling your ankle inward. This can force your peroneal tendon to quickly bring your foot back into alignment, which can cause the tendon to stretch and exert beyond its capacity. An acute tear results from a singular moment which the patient can recall.
2. Chronic Tears
   1. Chronic tears are seen more often than acute tears. These typically develop slowly and over time due to gradual stressors and pressure on the tendon. Pain can fluctuate and patients aren’t always able to pinpoint what’s causing it. 

Often, healthcare providers use a grading scale to better classify peroneal tendon tears:

1. Grade 1 (mild)
   1. A Grade 1 or mild tear is when the tendon has stretched beyond its normal limits, but it can still stabilize the foot and ankle adequately. There may be mild swelling or tenderness associated with this type of tear.
2. Grade 2 (moderate)
   1. A Grade 2 or moderate tear is when the tendon visibly has a partial tear, accompanied by moderate tenderness and swelling at the site of the injury. The ankle may also be mild to moderately unstable. 
3. Grade 3 (severe)
   1. A Grade 3 or severe tear is when the tendon is completely torn into two separate pieces. Many providers will refer to this as a rupture. This type of tear will most likely require a surgery to repair.

Diagnosis for Peroneal Tendon Injuries:

To better assess the severity of the tear incurred, your healthcare provider will examine the injury and ask questions about when your symptoms started. If needed, imaging tests, such as x-rays, MRI scans or CT scans, may be ordered to get a better look at the affected tendon.

Treatment for Peroneal Tendon Injuries:

Treatment for a Peroneal Tendon Injury will heavily depend on the severity of the tear. Conservative measures for treatment and rehabilitation include anti-inflammatory medications, resting and decreasing physical activity, immobilizing your foot with the help of a brace or boot, physical therapy, and even regenerative therapies such as prolotherapy, PRP, injections, dry needling, and deep massages. If conservative measures don’t move the needle for you in your treatment, your doctor or surgeon may recommend a surgery to restore the function of the peroneal tendon.