Peroneus Brevis Tears

  • P. KvardaEmail author
  • P. A. D. Van Dijk
  • G. R. Waryasz
  • C. W. DiGiovanni


Peroneal tendon tears are relatively common and often the result of athletic activity. The peroneus brevis (PB) tendon is injured most frequently, due to its vulnerable position between the peroneus longus (PL) tendon and the fibula. Plantar flexion and inversion are the most common mechanisms of injury, although there are other anatomical and etiological factors that can lead to peroneal tendinopathy. The most common presenting symptom is posterolateral ankle pain centered at, just above, or just below the tip of the fibula. Both ultrasound and magnetic resonance imaging (MRI) are excellent imaging modalities to identify tendon tear, but not all tears can be directly visualized with current technology. The treatment of symptomatic tears is usually operative, and there are numerous techniques to address the injured tendon depending on the degree of pathology and functional expectations of the patient.


Peroneus brevis tendon tear Posterolateral ankle pain Peroneal tendons Tendon tear Tendon repair Tendon transfer 


  1. 1.
    Rebecca A, Cerrato MSM. Peroneal tendon tears, sSurgical manageament and its complications. Foot Ankle Clin N Am. 2009;14:299–312.Google Scholar
  2. 2.
    van Dijk PA, Miller D, Calder J, DiGiovanni CW, Kennedy JG, Kerkhoffs GM, et al. The ESSKA-AFAS international consensus statement on peroneal tendon pathologies. Knee Surg Sports Traumatol Arthrosc. 2018; epub ahead of print.Google Scholar
  3. 3.
    Meyers A. Further evidences of attrition in the human body. Am J Anat. 1924;34:241–67.Google Scholar
  4. 4.
    Monteggia G. Instiuzini chirurgiche parte secondu; 1803. p. 336–41.Google Scholar
  5. 5.
    Piper S. Foot and ankle sports medicine. J Can Chiropractic Assoc. 2014;58(4):481.Google Scholar
  6. 6.
    Southerland JT, Boberg JS, Downey MS, Nakra A, Rabjohn LV. McGlamry’s comprehensive textbook of foot and ankle surgery, vol. 1. 4th ed; 2013. p. 1165–6.Google Scholar
  7. 7.
    Roster B, Michelier P, Giza E. Peroneal tendon disorders. Clin Sports Med. 2015;34(4):625–41.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Sobel M, Geppert MJ, Hannafin JA, Bohne WH, Arnoczky SP. Microvascular anatomy of the peroneal tendons. Foot Ankle. 1992;13(8):469–72.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Petersen W, Bobka T, Stein V, Tillmann B. Blood supply of the peroneal tendons: injection and immunohistochemical studies of cadaver tendons. Acta Orthop Scand. 2000;71(2):168–74.PubMedPubMedCentralGoogle Scholar
  10. 10.
    van Dijk PAD, Madirolas FX, Carrera A, Kerkhoffs GMMJ, Reina F. Peroneal tendons well vascularized: results from a cadaveric study. Knee Surg Sports Traumatol Arthrosc. 2016;24:1140–7.PubMedPubMedCentralGoogle Scholar
  11. 11.
    Ziai P, Benca E, von Skrbensky G, Graf A, Wenzel F, Basad E, et al. The role of the peroneal tendons in passive stabilisation of the ankle joint: an in vitro study. Knee Surg Sports Traumatol Arthrosc. 2013;21(6):1404–8.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Hatch GF, Labib SA, Rolf RH, Hutton WC. Role of the peroneal tendons and superior peroneal retinaculum as static stabilizers of the ankle. J Surg Orthop Adv. 2007;16(4):187–91.PubMedGoogle Scholar
  13. 13.
    Hecker P. Study on the peroneus on the tarsus. Anat Rec. 1923;26:79–82.Google Scholar
  14. 14.
    Sobel M, Levy ME, Bohne WH. Congenital variations of the peroneus quartus muscle: an anatomic study. Foot Ankle. 1990;11(2):81–9.PubMedPubMedCentralGoogle Scholar
  15. 15.
    Cheung YY, Rosenberg ZS, Ramsinghani R, Beltran J, Jahss MH. Peroneus quartus muscle: MR imaging features. Radiology. 1997;202(3):745–50.Google Scholar
  16. 16.
    Bilgili MG, Kaynak G, Botanlioglu H, Basaran SH, Ercin E, Baca E, et al. Peroneus quartus: prevalence and clinical importance. Arch Orthop Trauma Surg. 2014;134(4):481–7.PubMedPubMedCentralGoogle Scholar
  17. 17.
    Geller J, Lin S, Cordas D, Vieira P. Relationship of a low-lying muscle belly to tears of the peroneus brevis tendon. Am J Orthop (Belle Mead NJ). 2003;32(11):541–4.Google Scholar
  18. 18.
    Davda K, Malhotra K, O’Donnell P, Singh D, Cullen N. Peroneal tendon disorders. EFORT Open Rev. 2017;2(6):281–92.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Hyer CF, Dawson JM, Philbin TM, Berlet GC, Lee TH. The peroneal tubercle: description, classification, and relevance to peroneus longus tendon pathology. Foot Ankle Int. 2005;26(11):947–50.PubMedPubMedCentralGoogle Scholar
  20. 20.
    Dombek MF, Lamm BM, Saltrick K, Mendicino RW, Catanzariti AR. Peroneal tendon tears: a retrospective review. J Foot Ankle Surg: Off Publ Am Coll Foot Ankle Surg. 2003;42(5):250–8.Google Scholar
  21. 21.
    Larsen E. Longitudinal rupture of the peroneus brevis tendon. J Bone Joint Surg. 1987;69(2):340–1.Google Scholar
  22. 22.
    BF DG, Fraga CJ, Cohen BE, Shereff MJ. Associated injuries found in chronic lateral ankle instability. Foot Ankle Int. 2000;21(10):809–15.Google Scholar
  23. 23.
    Sammarco GJ, DiRaimondo CV. Chronic peroneus brevis tendon lesions. Foot Ankle. 1989;9(4):163–70.PubMedPubMedCentralGoogle Scholar
  24. 24.
    Sobel M, Warren RF, Brourman S. Lateral ankle instability associated with dislocation of the peroneal tendons treated by the Chrisman-Snook procedure. A case report and literature review. Am J Sports Med. 1990;18(5):539–43.PubMedPubMedCentralGoogle Scholar
  25. 25.
    Saupe N, Mengiardi B, Pfirrmann CW, Vienne P, Seifert B, Zanetti M. Anatomic variants associated with peroneal tendon disorders: MR imaging findings in volunteers with asymptomatic ankles. Radiology. 2007;242(2):509–17.Google Scholar
  26. 26.
    Chilvers M, Manoli A 2nd. The subtle cavus foot and association with ankle instability and lateral foot overload. Foot Ankle Clin. 2008;13(2):315–24, vii.PubMedGoogle Scholar
  27. 27.
    Selmani E, Gjata V, Gjika E. Current concepts review: peroneal tendon disorders. Foot Ankle Int. 2006;27(3):221–8.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Borton DC, Lucas P, Jomha NM, Cross MJ, Slater K. 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.Google Scholar
  29. 29.
    Sobel M, DiCarlo EF, Bohne WH, Collins L. Longitudinal splitting of the peroneus brevis tendon: an anatomic and histologic study of cadaveric material. Foot Ankle. 1991;12(3):165–70.PubMedPubMedCentralGoogle Scholar
  30. 30.
    Miura K, Ishibashi Y, Tsuda E, Kusumi T, Toh S. Split lesions of the peroneus brevis tendon in the Japanese population: an anatomic and histologic study of 112 cadaveric ankles. J Orthop Sci. 2004;9(3):291–5.PubMedGoogle Scholar
  31. 31.
    Sharma P, Maffulli N. Tendon injury and tendinopathy: healing and repair. J Bone Joint Surg Am. 2005;87(1):187–202.PubMedPubMedCentralGoogle Scholar
  32. 32.
    Kojima Y, Kataoka Y, Suzuki S, Akagi M. Dislocation of the peroneal tendons in neonates and infants. Clin Orthop Relat Res. 1991;266:180–4.Google Scholar
  33. 33.
    Cerrato RA, Myerson MS. Peroneal tendon tears, surgical management and its complications. Foot Ankle Clin. 2009;14(2):299–312.PubMedPubMedCentralGoogle Scholar
  34. 34.
    Sobel M, Geppert MJ, Olson EJ, Bohne WH, Arnoczky SP. The dynamics of peroneus brevis tendon splits: a proposed mechanism, technique of diagnosis, and classification of injury. Foot Ankle. 1992;13(7):413–22.PubMedPubMedCentralGoogle Scholar
  35. 35.
    Manoli A 2nd, Graham B. The subtle cavus foot, "the underpronator". Foot Ankle Int. 2005;26(3):256–63.PubMedPubMedCentralGoogle Scholar
  36. 36.
    Stiell IG, McKnight RD, Greenberg GH, McDowell I, Nair RC, Wells GA, et al. Implementation of the Ottawa ankle rules. JAMA. 1994;271(11):827–32.PubMedGoogle Scholar
  37. 37.
    Philbin TM, Landis GS, Smith B. Peroneal tendon injuries. J Am Acad Orthop Surg. 2009;17(5):306–17.PubMedGoogle Scholar
  38. 38.
    Heckman DS, Gluck GS, Parekh SG. Tendon disorders of the foot and ankle, part 1: peroneal tendon disorders. Am J Sports Med. 2009;37(3):614–25.PubMedPubMedCentralGoogle Scholar
  39. 39.
    Grant TH, Kelikian AS, Jereb SE, McCarthy RJ. Ultrasound diagnosis of peroneal tendon tears. A surgical correlation. J Bone Joint Surg Am. 2005;87(8):1788–94.Google Scholar
  40. 40.
    Wang XTRZ, Mechlin MB, Schweitzer ME. Normal variants and diseases of the peroneal tendons and superior peroneal retinaculum: MR imaging features. Radiographics. 2005;25:587–602.PubMedPubMedCentralGoogle Scholar
  41. 41.
    Lee SJ, Jacobson JA, Kim SM, Fessell D, Jiang Y, Dong Q, et al. Ultrasound and MRI of the peroneal tendons and associated pathology. Skelet Radiol. 2013;42(9):1191–200.Google Scholar
  42. 42.
    Kijowski R, De Smet A, Mukharjee R. Magnetic resonance imaging findings in patients with peroneal tendinopathy and peroneal tenosynovitis. Skelet Radiol. 2007;36(2):105–14.Google Scholar
  43. 43.
    Res LCS, Dixon T, Lubberts B, Vicentini JRT, van Dijk PA, Hosseini A, et al. Peroneal tendon tears: we should consider looking at the muscle instead. J Am Acad Orthop Surg. 2018;26(22):809–15.PubMedGoogle Scholar
  44. 44.
    Wong-Chung J, Marley WD, Tucker A, O’Longain DS. Incidence and recognition of peroneal tendon dislocation associated with calcaneal fractures. Foot Ankle Surg: Off J Eur Soc Foot Ankle Surg. 2015;21(4):254–9.Google Scholar
  45. 45.
    Wertheimer SJWC, Loder BG, Calderone DR, Frascone ST. The role of endoscopy in treatment of stenosing posterior tibial tenosynovitis. J Foot Ankle Surg. 1995;34:15–22.PubMedGoogle Scholar
  46. 46.
    van Dijk CNSP, Kort N. Tendoscopy (tendon sheath endoscopy) for overuse tendon injuries. Oper Tech Sports Med. 1997;5:170–8.Google Scholar
  47. 47.
    Cychosz CC, Phisitkul P, Barg A, Nickisch F, van Dijk CN, Glazebrook MA. Foot and ankle tendoscopy: evidence-based recommendations. Arthroscopy. 2014;30(6):755–65.PubMedGoogle Scholar
  48. 48.
    Marmotti A, Cravino M, Germano M, Del Din R, Rossi R, Tron A, et al. Peroneal tendoscopy. Curr Rev Musculoskelet Med. 2012;5(2):135–44.PubMedPubMedCentralGoogle Scholar
  49. 49.
    Scholten PE, van Dijk CN. Tendoscopy of the peroneal tendons. Foot Ankle Clin. 2006;11(2):415–20. viiPubMedGoogle Scholar
  50. 50.
    Scholten PE, Breugem SJ, van Dijk CN. Tendoscopic treatment of recurrent peroneal tendon dislocation. Knee Surg Sports Traumatol Arthrosc. 2013;21(6):1304–6.PubMedGoogle Scholar
  51. 51.
    Michels F, Jambou S, Guillo S, Van Der Bauwhede J. Endoscopic treatment of intrasheath peroneal tendon subluxation. Case Rep Med. 2013;2013:274685.PubMedGoogle Scholar
  52. 52.
    Lui TH. Endoscopic resection of the peroneal tubercle. J Foot Ankle Surg. 2012;51(6):813–5.Google Scholar
  53. 53.
    Lui TH. Tendoscopic resection of low-lying muscle belly of peroneus brevis or quartus. Foot Ankle Int. 2012;33(10):912–4.PubMedPubMedCentralGoogle Scholar
  54. 54.
    Panchbhavi VKM, Trevino SG. The technique of peroneal tendoscopy and its role in management of peroneal tendon anomalies. Tech Foot Ankle Surg. 2003;2(3):192–8.Google Scholar
  55. 55.
    Sammarco VJ. Peroneal tendoscopy: indications and techniques. Sports Med Arthrosc Rev. 2009;17(2):94–9.PubMedGoogle Scholar
  56. 56.
    Dallaudiere B, Pesquer L, Meyer P, Silvestre A, Perozziello A, Peuchant A, et al. Intratendinous injection of platelet-rich plasma under US guidance to treat tendinopathy: a long-term pilot study. J Vasc Intervent Radiol: JVIR. 2014;25(5):717–23.Google Scholar
  57. 57.
    Krause JO, Brodsky JW. Peroneus brevis tendon tears: pathophysiology, surgical reconstruction, and clinical results. Foot Ankle Int. 1998;19(5):271–9.PubMedPubMedCentralGoogle Scholar
  58. 58.
    Redfern D, Myerson M. The management of concomitant tears of the peroneus longus and brevis tendons. Foot Ankle Int. 2004;25(10):695–707.PubMedPubMedCentralGoogle Scholar
  59. 59.
    Ellis SJ, Rosenbaum AJ. Hamstring autograft reconstruction of the peroneus brevis. Techn Foot Ankle Surg. 2018;17(1):3–7.Google Scholar
  60. 60.
    Pellegrini MJ, Glisson RR, Matsumoto T, Schiff A, Laver L, Easley ME, et al. Effectiveness of allograft reconstruction vs tenodesis for irreparable peroneus brevis tears: a cadaveric model. Foot Ankle Int. 2016;37(8):803–8.PubMedPubMedCentralGoogle Scholar
  61. 61.
    Mook WR, Parekh SG, Nunley JA. Allograft reconstruction of peroneal tendons: operative technique and clinical outcomes. Foot Ankle Int. 2013;34(9):1212–20.PubMedPubMedCentralGoogle Scholar
  62. 62.
    Coughlin MJ, Saltzman CL, Anderson RB. Mann’s surgery of the foot and ankle, vol. 1. 9th ed; 2014. p. 1250.Google Scholar
  63. 63.
    Coughlin MJ, Saltzman CL, Anderson RB. Mann’s surgery of the foot and ankle, vol. 1. 9th ed; 2014. p. 1257–9.Google Scholar
  64. 64.
    Jockel JR, Brodsky JW. Single-stage flexor tendon transfer for the treatment of severe concomitant peroneus longus and brevis tendon tears. Foot Ankle Int. 2013;34(5):666–72.Google Scholar
  65. 65.
    Seybold JD, Campbell JT, Jeng CL, Short KW, Myerson MS. Outcome of lateral transfer of the FHL or FDL for concomitant peroneal tendon tears. Foot Ankle Int. 2016;37(6):576–81.PubMedPubMedCentralGoogle Scholar
  66. 66.
    Seybold JD, Campbell JT, Jeng CL, Myerson MS. Anatomic comparison of lateral transfer of the long flexors for concomitant peroneal tears. Foot Ankle Int. 2013;34(12):1718–23.PubMedPubMedCentralGoogle Scholar
  67. 67.
    van Dijk PA, Lubberts B, Verheul C, DiGiovanni CW, Kerkhoffs GM. Rehabilitation after surgical treatment of peroneal tendon tears and ruptures. Knee Surg Sports Traumatol Arthrosc: Off J ESSKA. 2016;24(4):1165–74.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • P. Kvarda
    • 1
    • 2
    Email author
  • P. A. D. Van Dijk
    • 3
  • G. R. Waryasz
    • 1
    • 4
  • C. W. DiGiovanni
    • 1
    • 4
  1. 1.Massachusetts General Hospital, Harvard Medical SchoolBostonUSA
  2. 2.University Hospital of Basel, Department of Orthopedics and TraumatologyBaselSwitzerland
  3. 3.Orthopedic Research Department, Academisch Medisch Centrum, Universiteit van AmsterdamAmsterdamThe Netherlands
  4. 4.Newton-Wellesley HospitalNewtonUSA

Personalised recommendations