Peroneal Tendon Rupture

ExitCare ImagePeroneal tendon rupture is a complete tear in one of the two peroneal tendons, on the outside of the ankle. These tendons attach two muscles (peroneus longus and peroneus brevis) to the bones of the ankle. These two muscles are used to straighten the foot, (standing on "tippy toes" or jumping), and for turning the foot to the outside. A rupture of one of these tendons impairs the ankle's ability to perform these motions.

SYMPTOMS

  • A "pop" or rip felt behind the outer part of the ankle.

  • Pain and weakness when moving the foot (especially when pushing down with the front of the foot or turning it inward).

  • Inability or weakness when trying to stand on the toes or ball of the foot.

  • Tenderness, swelling, warmth, and redness around the outside of the ankle.

  • Bruising in the area of injury, after 48 hours.

CAUSES

Peroneal tendon ruptures are often due to persistent (chronic) injury, but may also occur from severe (acute) injury. The peroneal tendons lie in a groove on the side of the ankle. Repeated, stressful movements may wear these tendons down over time, causing them to rupture. The tendon may also rupture if a severe injury places a force on one of the tendons, that is greater than it can handle. Common causes of severe injury tendon ruptures include jumping, hurdling, or beginning a sprint. In rare cases, the tendon is ruptured due to a cut (laceration).

RISK INCREASES WITH:

  • Sports that require sudden, explosive muscle contraction (jumping or quick starts).

  • Sports that involve kicking with the outer part of the foot (martial arts).

  • Poor foot strength and flexibility.

  • Previous or concurrent ankle sprain.

  • Previous or untreated peroneal tendon injury.

  • Corticosteroid injection into the peroneal tendon.

  • Increasing age and medical problems. (Obesity or decreased circulation due to heart problems.)

PREVENTION

  • Warm up and stretch before activity.

  • Allow enough time for rest and recovery between activities.

  • Maintain physical fitness:

  • Ankle and leg flexibility.

  • Muscle strength and endurance.

  • Cardiovascular fitness.

  • Arch supports (orthotics), taping, protective strapping, or an adhesive bandage may be advised before activity.

  • Complete rehabilitation for a previous ankle or foot injury, before returning to competition or practice.

PROGNOSIS

Peroneal tendon ruptures can often be cured with surgery and a recovery period of 4 to 9 months.

RELATED COMPLICATIONS

  • Weakness of the peroneal muscles, especially if untreated. This results in problems standing on the toes and pushing off.

  • Repeated rupture of the tendon, after treatment.

  • Pain with walking.

  • Prolonged impairment.

  • Risks of surgery: infection, injury to nerves (numbness, weakness), bleeding, ankle stiffness.

TREATMENT

Treatment first involves stopping any activity that makes your symptoms worse. You should not walk on the affected ankle. Ice, medicine, and elastic compression bandages may reduce pain and inflammation. Definitive treatment for peroneal tendon rupture is surgery. Non-surgical treatment is reserved for people with medical conditions that prevent them from undergoing surgery, or for those with chronic injury. Surgery to fix a peroneal tendon rupture involves sewing the tendon back onto the bone. If this is not possible, the surgeon may sew the ruptured tendon to the remaining, intact peroneal tendon. Surgery is followed by restraining the ankle. Physical therapy is often advised afterward.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often advised.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers may be given, if needed. Use only as directed and only as much as you need.

SEEK MEDICAL CARE IF:

  • Pain increases, despite treatment.

  • Cast discomfort develops.

  • Any of the following occur after surgery:

  • You experience pain, numbness, or coldness in the foot and ankle.

  • Blue, gray, or dark color appears in the toenails.

  • You develop signs of infection: fever, increased pain, swelling, redness, drainage of fluids, or bleeding in the affected area.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)