Peroneal muscle injuries
The peroneus longus and brevis muscles are important elements of the foot’s dynamic structure.
The tendons of these muscles run just behind the lateral malleolus, so injuries to them may accompany ankle sprains.
A characteristic feature of peroneal-muscle disorders is swelling just behind the lateral malleolus
The most common pathologies affecting these important structures are:
01
Inflammation of the tendon and its sheaths
Causes
- ankle sprain
- ankle fracture
- overgrown bony structures – the so-called peroneal tubercle or an accessory malleolus along the tendon itself
Symptoms
- pain that worsens while walking and when raising the medial edge of the foot
- swelling just behind the lateral malleolus
- tenderness behind the lateral malleolus
Diagnosis
- orthopaedic examination
- ultrasound
- Magnetic resonance imaging
Treatment
- non-surgical – physical procedures, exercises, orthoses and immobilization in a plaster cast are used
- surgical – endoscopic debridement of the tendon and its sheaths, with removal of additional bony structures.
Postoperative management includes immobilization in a short plaster splint for 2 weeks, followed by an ankle orthosis of the ‘Walker’ type for another 6 weeks. Normal foot function returns after approximately 12–16 weeks.
02
Loss of continuity of the peroneal tendons
Causes
- very severe ankle sprain
- ankle fracture
- repeated minor ankle-sprain injuries
Symptoms
- a sensation of a ‘snap’ behind the lateral malleolus accompanied by severe pain
- swelling just behind the lateral malleolus
- tenderness behind the lateral malleolus
Diagnosis
- orthopaedic examination
- ultrasound
- Magnetic resonance imaging
Treatment
- non-surgical – physical procedures, exercises, orthoses and immobilization in a plaster cast, as well as orthoses, are used
- surgical – cleaning and restoring the proper shape of the damaged tendon; strengthening it with an adjacent tendon or reconstructing it using a graft
- Postoperative management includes immobilization in a short plaster splint for 2 weeks, followed by an ankle orthosis of the ‘Walker’ type for another 6 weeks. Normal foot function returns after approximately 12–16 weeks.
03
Dislocation and instability of the peroneal muscles
Causes
- ankle sprain
- ankle fracture
Symptoms
- pain that worsens while walking and when raising the medial edge of the foot
- swelling just behind the lateral malleolus
- tenderness behind the lateral malleolus
- a sensation of ‘snapping’ behind the lateral malleolus during dorsiflexion of the foot
- a feeling of ankle instability and insecurity
Diagnosis
- orthopaedic examination
- X-ray
- ultrasound
- Magnetic resonance imaging
Treatment
- non-surgical – highly ineffective and reserved for people unable to undergo surgical treatment. Physical procedures, exercises, orthoses and immobilization in a plaster cast are used
- surgical – involves direct repair of the tissues stabilizing the tendons, with appropriate suturing and positioning of the damaged structures.
- Postoperative management includes immobilization in a short plaster splint for 2 weeks, followed by an ankle orthosis of the ‘Walker’ type for another 6 weeks. Normal foot function returns after approximately 12–16 weeks.
