Brian C. Toolan MD
Orthopaedic Foot and Ankle Surgery
The University of Chicago
Section of Orthopaedic Surgery and Rehabilitation Medicine
5841 S. Maryland Ave. MC 3079 Chicago Illinois 60637
Phone 773.702.6984 Fax 773.702.0076
Peroneal Tendonitis/Subluxation
Tendons connect muscles to bones. They stretch across joints and allow them to move. The peroneal tendons are some of the most important tendons in the foot. They are located on the outside of the ankle, running behind the fibula and attaching to the lateral border of the foot.
The peroneal tendons are responsible for inversion and eversion of the foot and balance on uneven surfaces. If this tendon gets inflamed, over-stretched, or torn you may have pain that starts around the back of your fibula bone that may radiate to the lateral border of the foot and possibly up the outer part of your leg.
Signs and symptoms include the following; pain and swelling on the outside of your foot and ankle, tenderness along the course of the tendon when under the stress of activity, and”popping” sensations.
Subluxation of the peroneal tendons is a condition that causes a recurrent snap or popping sensation on the lateral border of the foot. Subluxation or displacement of the tendons, occurs during motion while the tendon is being loaded. The slipping sensation occurs as the tendons slip out a grove behind the fibula and back into the groove.
Causes
Common causes of peroneal tendonitis include lateral ankle sprains, poor fitting shoes causing irritation of the tendons, returning too quickly to activity after an ankle injury has been properly rehabilitated, or hypermobility of the tendons, from a tear of a ligament that holds the tendons in place or the tear of one of tendons themselves (which would cause the snapping).
Diagnosis
The diagnosis is based on both history and physical exam. The physician will look at your feet, and test the strength of the tendons. You may or may not get x-rays or an MRI.
Treatment
The first treatment options are conservative. Ice and anti-inflammatory medications are used to help decrease pain and inflammation. Depending on the severity of tendonitis, you may be treated with orthotics, splinting or casting to rest the tendon. After resting the tendon, and making it pain free, physical therapy is started to rehabilitate the tendons.
If rehabilitation fails, and you continue to have pain, your physician should evaluate your tendons with an MRI. If there are MRI findings, you may require surgery to repair the tendons, the ligament that holds the tendons in place, and possibly deepening of the groove in which the tendons sit.
Surgery can usually be performed on an outpatient basis. It will require you to be non-weight-bearing in a cast for four weeks to allow the tendon repair to heal. After four weeks of casting you will attend physical therapy 2-3 times per week for 6-10 weeks, to return to full-weight-bearing, and regain motion and strength.
Peroneal tendon subluxation
Normal Peroneal Tendons
Peroneus Brevis Split
Peroneal Tendon Repair