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Peroneal Tendinopathy

Aka: Peroneal Tendinopathy, Peroneal Tendonitis, Peroneal Tendinitis, Peroneus Longus Tenosynovitis, Peroneus Brevis Tenosynovitis, Peroneus Longus Tendinitis, Peroneus Brevis Tendinitis
  1. Physiology
    1. Peroneus Longus and Brevis act function in ankle eversion and plantar flexion
    2. Images
      1. ankleMedialAndLateral.jpg
  2. Mechanism
    1. Running Injury (overuse)
    2. Lateral Ankle Sprain (ankle inversion injury, esp. in first degree sprains)
      1. Injury may be to Peroneus Longus, or more commonly to Peroneus Brevis
  3. Risk Factors
    1. Varus hindfoot (heel varus)
    2. Forefoot striking pattern (esp. Running Injury)
  4. Symptoms
    1. Chronic lateral ankle pain (retrofibular), popping and swelling
    2. Ankle instability
  5. Signs
    1. Observation with patient standing
      1. Hindfoot varus (heel varus) with inverted foot and ankle
      2. Peroneal tendon may be seen contracting, overcoming inversion while maintaining stance
    2. Palpation
      1. Pain and swelling posterior to the lateral malleolus at the lateral hindfoot
    3. Provocative maneuvers
      1. Passive stretch foot and ankle in inversion and dorsiflexion
        1. Positive if painful
      2. Resisted foot eversion and plantar flexion
        1. Positive if weak or painful
        2. Palpate during resistance for tenderness along fibular groove (posterolateral ankle)
          1. Pain indicates a positive peroneal compression test
      3. Circumduct ankle
        1. Observe for peroneal tendon subluxation over the lateral malleolus
  6. Differential Diagnosis
    1. Ankle Sprain
    2. Fibular Fracture
    3. Peroneal Subluxation
    4. Os perineum syndrome (plantar lateral Foot Pain)
    5. Rheumatoid Arthritis (consider if lack of Trauma)
  7. Management
    1. RICE-M initially
    2. Modify activities
    3. Rehabilitation Exercises (consider physical therapy referral)
      1. Ankle Range of Motion
      2. Peroneal strengthening (Eversion strengthening and progressive loading)
      3. Proprioception Exercises
    4. Shoe Orthotic
      1. Lateral heel wedge to offload peroneal tendons
      2. First Metatarsal head recessed depression to increase foot valgus
      3. Heel cushion may offer comfort
    5. Peroneal Corticosteroid Injection
      1. Consider in refractory cases
      2. Appears effective and with low risk of tendon rupture
      3. Perform under Ultrasound guidance (consider Sports Medicine Referral)
      4. Fram (2019) Foot Ankle Int 40(8): 888-94 [PubMed]
      5. Muir (2011) Am J Phys Med Rehabil 90(7): 564-71 [PubMed]
    6. Orthopedic Referral Indications (possible surgical repair)
      1. Refractory to therapy above
      2. Inability to bear weight >1 to 2 weeks after injury
      3. Persistent or recurrent peroneal tendon instability
      4. Peroneal tendon rupture
  8. References
    1. Sammarco (1994) Orthop Clin North Am 25(1): 135-45
    2. Deu (2022) Am Fam Physician 105(5): 479-86 [PubMed]
    3. Simpson (2009) Am Fam Physician 80(10): 1107-13 [PubMed]

Peroneal tendinitis (C0263936)

Concepts Disease or Syndrome (T047)
ICD10 M76.7
SnomedCT 53208009
German Tendinitis der Peronaeussehne(n)
English peroneal tendinitis, peroneal tendinitis (diagnosis), Peroneal tendonitis, Peroneal tendinitis, Peroneal tendinitis (disorder), peroneal; tendinitis, tendinitis; peroneal
Korean 종아리 힘줄염
Spanish tendinitis del peroné (trastorno), tendinitis de músculo peroneo (trastorno), tendinitis de músculo peroneo, tendinitis del peroné
Dutch peroneus; tendinitis, tendinitis; peroneus, Tendinitis van peroneuspees
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Peroneus brevis tenosynovitis (C0410135)

Concepts Disease or Syndrome (T047)
SnomedCT 202923005
English Peroneus brevis tenosynovitis, Peroneus brevis tenosynovitis (disorder)
Spanish tenosinovitis del músculo peroneo lateral corto (trastorno), tenosinovitis del músculo peroneo lateral corto
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Peroneus longus tenosynovitis (C0457599)

Concepts Disease or Syndrome (T047)
SnomedCT 202922000
English Peroneus longus tenosynovitis, Peroneus longus tenosynovitis (disorder)
Spanish tenosinovitis del músculo peroneo lateral largo (trastorno), tenosinovitis del músculo peroneo lateral largo
Sources
Derived from the NIH UMLS (Unified Medical Language System)


peroneus brevis tendinitis (C2057345)

Concepts Disease or Syndrome (T047)
English peroneus brevis tendinitis (diagnosis), peroneus brevis tendinitis
Sources
Derived from the NIH UMLS (Unified Medical Language System)


peroneus longus tendinitis (C2057346)

Concepts Disease or Syndrome (T047)
English peroneus longus tendinitis, peroneus longus tendinitis (diagnosis)
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Tendinopathy of peroneal tendon (C3838762)

Concepts Disease or Syndrome (T047)
SnomedCT 700354000
English Tendinopathy of peroneal tendon, Disorder of peroneal tendon, Disorder of peroneal tendon (disorder)
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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