Peroneal tendon pathologies account for a preponderance of posterolateral ankle complaints and can turn into serious disability if not addressed properly. In order to prevent further impairment of the tendon tissue and, moreover, to prevent chronic pain, adequate treatment in an early stage is essential. Careful patient history and clinical examination is often the key to the diagnosis. Peroneal tendoscopy is an adequate instrument to confirm the clinical diagnosis or to provide insight when in doubt. It allows visualization of the peroneal tendons from the myotendinous junction to the peroneal tubercle without damaging the soft tissue around the tendons. Moreover, it provides proper dynamic evaluation of the tendons.
Tendinopathies linked to the peroneal tendons are generally classified into three main categories: (1) tendinopathies (tendinitis, tenosynovitis, tendinosis, and stenosis), (2) (partial) tears and ruptures, and (3) subluxation and dislocation. Treatment of these pathologies is primarily indicated by pain. In general, the first choice of treatment is conservative, but surgical intervention is recommended if this fails. Traditional open treatment is associated with complications including damage to the superior peroneal retinaculum, surgical scar formation, adhesions of the tendons, and peroneal nerve dysaesthesia, so the need for less invasive options became bigger. In comparison to open surgery, peroneal tendoscopy is associated with less morbidity, smaller scars, less postoperative pain and complications, a functional rehabilitation and good functional outcomes.
This chapter provides an overview of the anatomy, patient history, clinical examination, and diagnostics of peroneal tendon pathologies and proposes a technique for peroneal tendoscopy.
Edwards M. The relations of the peroneal tendons to the fibula, calcaneus, and cuboideum. Am J Anat. 1928;42:213–53.CrossRefGoogle Scholar
Freccero DM, Berkowitz MJ. The relationship between tears of the peroneus brevis tendon and the distal extent of its muscle belly: an MRI study. Foot Ankle Int. 2006;27(4):236–9.PubMedCrossRefGoogle Scholar
Saupe N, et al. Anatomic variants associated with peroneal tendon disorders: MR imaging findings in volunteers with asymptomatic ankles. Radiology. 2007;242(2):509–17.PubMedCrossRefGoogle Scholar
Mota J, Rosenberg ZS. Magnetic resonance imaging of the peroneal tendons. Topics Magnet Reson Imaging. 1998;9(5):273–85.Google Scholar
Kumai T, Benjamin M. The histological structure of the malleolar groove of the fibula in man: its direct bearing on the displacement of peroneal tendons and their surgical repair. J Anat. 2003;203(2):257–62.PubMedPubMedCentralCrossRefGoogle Scholar
Petersen W, et al. Blood supply of the peroneal tendons: injection and immunohistochemical studies of cadaver tendons. Acta Orthop Scand. 2000;71(2):168–74.PubMedCrossRefGoogle Scholar
Borton DC, et al. Operative reconstruction after transverse rupture of the tendons of both peroneus longus and brevis. Surgical reconstruction by transfer of the flexor digitorum longus tendon. J Bone Joint Surg. 1998;80(5):781–4.CrossRefGoogle Scholar
Brandes CB, Smith RW. Characterization of patients with primary peroneus longus tendinopathy: a review of twenty-two cases. Foot Ankle Int. 2000;21(6):462–8.PubMedCrossRefGoogle Scholar
Rosenberg ZS, et al. Peroneal tendon injury associated with calcaneal fractures: CT findings. AJR Am J Roentgenol. 1987;149(1):125–9.PubMedCrossRefGoogle Scholar
Truong DT, et al. Fracture of the os peroneum and rupture of the peroneus longus tendon as a complication of diabetic neuropathy. Skelet Radiol. 1995;24(8):626–8.CrossRefGoogle Scholar
Vainio K. The rheumatoid foot. A clinical study with pathological and roentgenological comments. Clin Orthopaed Relat Res. 1956;265:4–8.Google Scholar
Wright DG, Sangeorzan BJ. Calcaneal fracture with peroneal impingement and tendon dysfunction. Foot Ankle Int. 1996;17(10):650.PubMedCrossRefGoogle Scholar
Safran MR, et al. Peroneal tendon subluxation in athletes: new exam technique, case reports, and review. Med Sci Sports Exerc. 1999;31(7 Suppl):487–92.CrossRefGoogle Scholar
Church CC. Radiographic diagnosis of acute peroneal tendon dislocation. AJR Am J Roentgenol. 1977;129(6):1065–8.PubMedCrossRefGoogle Scholar