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Case Reports
. 2024 Nov 15;16(11):e73787.
doi: 10.7759/cureus.73787. eCollection 2024 Nov.

Peroneal Tendon Tears: Four Simple-to-Complex Cases

Zhi Hao Tang  1 , Keen Wai Chong  2
Affiliations
Case Reports

Peroneal Tendon Tears: Four Simple-to-Complex Cases

Zhi Hao Tang et al. Cureus. .

Abstract

Peroneal tears are an important cause of lateral ankle pain and are often missed. Peroneal tears can present in different combinations requiring different surgical strategies. If the tears are symptomatic in patients in whom conservative treatment has failed, surgery is an option. We present the various types of surgical management of four patients, each with a different tear combination of the peroneal tendons. The first patient presented with a longitudinal split of the peroneal brevis tendon, which was repaired. The second patient had a tear of the peroneal longus tendon with a significant gap, while his peroneal brevis tendon was intact. His peroneal longus was tenodesed to the intact peroneal brevis. The third patient had ruptures of both his peroneal brevis and longus tendons with significant gaps. There was only a small peroneal brevis remnant left. The patient also had a cavovarus deformity of the same foot. His flexor hallucis longus tendon was harvested, routed, and sutured to the remnant peroneal brevis tendon. A lateralising calcaneal osteotomy and a dorsiflexion closing wedge osteotomy of his first metatarsal bone were also performed. The last patient had ruptures of both peroneal tendons with no remnant tendon remaining for repair. His anterior tibialis tendon was transferred from its insertion to his cuboid. A lateralising calcaneal osteotomy was performed, and an ankle-spanning external fixator was applied. A high index of suspicion for peroneal tears in lateral-sided ankle pain must be maintained. Peroneal tears can present in various combinations, with each combination requiring a different surgical treatment.

Keywords: cavovarus deformity; peroneal ruptures; peroneal tears; tendon repair; tendon transfer; tenodesis.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. MRI sagittal view of the patient’s right ankle showing the longitudinal split (red arrow) in the peroneal brevis with fluid in the sheath.
Figure 2
Figure 2. MRI coronal view of the patient‘s right ankle showing the distended fluid sheath (red arrow) of the peroneal brevis tendon.
Figure 3
Figure 3. Intraoperative photograph showing a longitudinal split in the patient’s peroneal brevis tendon (blue arrow).
Figure 4
Figure 4. Intraoperative photograph showing the repaired peroneal brevis tendon.
Figure 5
Figure 5. MRI sagittal image of the patient’s left ankle showing the proximal stump of the ruptured peroneal longus tendon (red arrow).
Figure 6
Figure 6. Intraoperative photograph of the lateral aspect of the patient’s left foot showing the proximal stump (blue arrow) of the peroneal longus rupture. The distal stump could not be found. The peroneal brevis tendon was intact. The sural nerve was safely retracted and protected with the vessel loop.
Figure 7
Figure 7. Intraoperative photo showing the proximal stump of the peroneal longus being tenodesed to the intact peroneal brevis tendon.
Figure 8
Figure 8. MRI sagittal image of the patient showing the proximal stumps (red arrow) of the ruptured peroneal brevis and longus tendons.
Figure 9
Figure 9. The flexor hallucis tendon delivered proximally, then posteriorly behind the tibia, and retrieved posterolaterally.
Figure 10
Figure 10. Pre-operative weight-bearing radiographs of the patient’s left foot.
Figure 11
Figure 11. Post-operative weight-bearing radiographs of the patient’s left foot.
Figure 12
Figure 12. Pre-operative weight-bearing views of the patient’s left ankle.
Figure 13
Figure 13. Post-operative weight-bearing views of the patient’s left ankle.
Figure 14
Figure 14. Clinical photograph of the patient’s varus hindfoot alignment.
Figure 15
Figure 15. Clinical photograph of the patient’s right foot in an inverted resting position.
Figure 16
Figure 16. MRI axial cuts showing absent distal remnants of both peroneal tendons (red arrow).
Figure 17
Figure 17. Pre-operative weight-bearing lateral radiographs of the patient’s right foot.
Figure 18
Figure 18. Post-operative weight-bearing lateral radiographs of the patient’s right foot.
Figure 19
Figure 19. Intraoperative photograph of the patient’s harvested anterior tibialis tendon.
Figure 20
Figure 20. Ankle-spanning external fixator was put on for six weeks.
Figure 21
Figure 21. Post-operative photo of the patient in a stable plantigrade position at three months post-surgery.
See this image and copyright information in PMC

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