What are they?
The peroneal tendons pass around the lateral side of the ankle. They are important in helping to flex the ankle joint and turn the foot out. They also help stabilise the ankle joint.
The peroneal muscles arise in the outer aspect of the lower leg and form two tendons which wind around the ankle and attach to the lateral side and underside of the foot.
What can go wrong?
The peroneal tendons are an important cause of pain and swelling around the lateral (outer) side of the ankle. Sometimes patients also complain that the ankle feels unstable or that they can feel a clicking sensation on the outer side of the joint.
The tendons can become inflamed and torn. Often there is a preceeding injury such as a severe ankle sprain which can be recalled. Sometimes there is no such event however some conditions such as diabetes, rheumatoid arthritis and ‘high-arch’ (cavovarus) feet can predispose you to these tendon problems. It is also possible for the tendons to become unstable and to dislocate out of the groove in which they normally sit.
How is it diagnosed?
A history is taken and an examination will often reveal swelling and tenderness along the course of the peroneal tendons. If the tendons are unstable, a snapping sensation may be felt.
X-rays are requested to exclude any underlying arthritis and an ultrasound or MRI can be useful to assess the severity of the problem.
What are the treatments?
The treatment is tailored to the underlying problem. Initially conservative measures will be tried such as rest, activity modification, anti-inflammatories and bracing.
If this fails then surgery is usually required. This entails repairing the tendon if possible or cutting out any abnormal tendon that is not repairable. Sometimes the damaged tendon needs to be transferred and attach to its neighbouring tendon. If the tendon is unstable then the tissue covering the tendon may need to be reconstructed.