Peroneal Tendon Injury
The peroneal tendons are two tendons
that lie immediately behind the outside bone of the ankle (the fibula).
These two tendons are responsible for moving the foot outwards in
a direction called eversion. They are important tendons because
they balance the ankle and the back of the foot and prevent the
foot from turning inwards repetitively. They are slightly weaker
than the muscles and tendons on the inside of the ankle and are
prone to injury as the ankle turns, rolls or becomes sprained.
Tears of these tendons do occur. One or both of the tendons can
be torn. This leads to swelling, pain and a sense of instability
behind the outside of the ankle. Occasionally the tendons can be
injured in either a fall or an athletic injury. They pop out of
the supporting ligaments that hold them in place and dislocate.
Once this occurs, recurrent dislocation and tearing of the tendons
If the tendons dislocate acutely in an injury, they need to be repaired
to prevent future tearing of the tendons.
||The peroneal tendons were dislocated
in an acute twisting injury. Left: Note the ridge of tendons
lying in front of the ankle.
Right: The thumb is attempting to push the tendons back.
Once dislocated, the tendons can only be replaced through
The diagnosis of peroneal tendon injury is made through careful
examination and palpation by the orthopedic surgeon. An MRI may
be required to more clearly document the extent of the tear. Once
a tear is diagnosed, surgery is necessary.
The tendons can be repaired by stitching. If they are severely torn,
they need to be replaced with new tendon tissue. Sometimes this
tendon tissue can be obtained from the same leg. At other times
allograft tendons are used. These come from the cadaver bank. The
allograft tendons are safe to use, have no immunogenic properties
and are not rejected. This procedure has been successfully performed
on professional athletes who have returned to national level competition.
||The peroneal tendons are shown on the
left, where they lie behind the fibula bone behind the
outside of the ankle. On the right, you can see a large
tear in the tendon.