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History and Physical Examination in Peroneal Tendon Injury

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Abstract

Lateral ankle pain is an extremely common complaint generally caused by an acute traumatic event and can also present as a chronic condition. The differential diagnosis is extensive but a thorough history and directed physical examination and simple radiographic tests should provide the physician with an accurate diagnosis. Over-reliance on advanced imaging should not be routine; these tests should be ordered, when appropriate, to confirm a presumptive diagnosis.

The key to effective management depends upon a timely and accurate diagnosis. Lateral ankle pain may result from injury to or abnormality of an intra-articular, extra-articular, boney, ligamentous, muscular, or tendinous structure. Peroneal tendon pathology is not rare; but it is frequently diagnosed late, when an ankle fails to improve. The peroneal tendons can be affected by tendonitis, tendinosis, tears, ruptures, subluxation, dislocation, and fracture or diastasis of an os peroneum. An accurate diagnosis of peroneal tendon abnormality depends upon the physician being able to perform a competent history and physical examination, and being cognizant of the various types, grades, locations, and nuances of peroneal tendon pathology.

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References

  1. Baumhauer JF, Nawoczenski DA, DiGiovanni BF, Flemister AS. Ankle pain and peroneal tendon pathology. Clin Sports Med. 2004;23:21–34.

    PubMed  Google Scholar 

  2. Brodsky JW, Zide JR, Kane JM. Acute peroneal injury. Foot Ankle Clin. 2017;22:833–41.

    PubMed  Google Scholar 

  3. Dombek MF, Lamm BM, Saltrick K, Mendicino RW, Catanzariti AR. Peroneal tendon tears: a retrospective review. J Foot Ankle Surg. 2003;42:250–8.

    PubMed  Google Scholar 

  4. Heckman DS, Gluck GS, Parekh SG. Tendon disorders of the foot and ankle, part 1 peroneal tendon disorders. Am J Sports Med. 2009;37:614–25.

    PubMed  Google Scholar 

  5. Roster B, Michelier P, Giza E. Peroneal tendon disorders. Clin Sports Med. 2015;34:625–41.

    PubMed  Google Scholar 

  6. Sammarco GJ. Peroneal tendon injuries. Orthop Clin North Am. 1994;25:135–45.

    CAS  PubMed  Google Scholar 

  7. Sammarco GJ, Mangone PG. Review article: diagnosis and treatment of peroneal tendon injuries. Foot Ankle Surg. 2000;6:197–205.

    Google Scholar 

  8. Slater HK. Acute peroneal tendon tears. Foot Ankle Clin. 2007;12:659–74.

    CAS  PubMed  Google Scholar 

  9. Wukich DK, Tuason DA. Diagnosis and treatment of chronic ankle pain. Instr Course Lect. 2011;60:335–50.

    PubMed  Google Scholar 

  10. Scanlan RL, Gehl RS. Peroneal tendon injuries. Clin Podiatr Med Surg. 2002;19:419–31.

    PubMed  Google Scholar 

  11. Lau BC, Moore LK, Thuillier DU. Evaluation and management of lateral ankle pain following injury. JBJS Rev. 2018;6:1–10.

    Google Scholar 

  12. Selmani E, Gjata V, Gjika E. Current concepts review: peroneal tendon disorders. Foot Ankle Int. 2006;27:221–8.

    PubMed  Google Scholar 

  13. Sharma P, Maffulli N. Current concepts review: tendon injury and tendinopathy: healing and repair. J Bone Joint Surg Am. 2005;87:187–202.

    PubMed  Google Scholar 

  14. Johnson KA, Strom DE. Tibialis posterior tendon dysfunction. Clin Orthop Relat Res. 1989;239:196–206.

    Google Scholar 

  15. Myerson MS. Adult acquired flatfoot deformity: treatment of dysfunction of the posterior tibial tendon. J Bone Joint Surg Am. 1996;78:780–92.

    Google Scholar 

  16. Hamilton WG, Geppert MJ, Thompson FM. Pain in the posterior aspect of the ankle in dancers. Differential diagnosis and operative treatment. J Bone Joint Surg Am. 1996;78:1491–500.

    CAS  PubMed  Google Scholar 

  17. Bizarro AH. On sesamoid and supernumerary bones of the limbs. J Anat. 1921;55:256–68.

    CAS  PubMed  PubMed Central  Google Scholar 

  18. Cerrato RA, Myerson MS. Peroneal tendon tears, surgical management and its complications. Foot Ankle Clin. 2009;14:299–312.

    PubMed  Google Scholar 

  19. Sobel M, Levy ME, Bohne WH. Congenital variations of the peroneus quartus muscle: an anatomic study. Foot Ankle Int. 1990;11:81–9.

    CAS  Google Scholar 

  20. 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;26:947–50.

    PubMed  Google Scholar 

  21. Bruce WD, Christoferson MR, Phillips DL. Stenosing tenosynovitis and impingement of the peroneal tendons associated with hypertrophy of the peroneal tubercle. Foot Ankle Int. 1999;20:464–7.

    CAS  PubMed  Google Scholar 

  22. Sobel M, Pavlov H, Geppert MJ, Thompson FM, DiCarlo EF, Davis WH. Painful os peroneum syndrome: a spectrum of conditions responsible for plantar lateral foot pain. Foot Ankle Int. 1994;15:112–24.

    CAS  PubMed  Google Scholar 

  23. Wang XT, Rosenberg ZS, Mechlin MB, Schweitzer ME. Normal variants and diseases of the peroneal tendons and superior peroneal retinaculum: MR imaging features. Radiographics. 2005;25:587–602.

    PubMed  Google Scholar 

  24. 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;71:168–74.

    CAS  PubMed  Google Scholar 

  25. Arbab D, Tingart M, Frank D, Abbara-Czardybon M, Waizy H, Wingenfeld C. Treatment of isolated peroneus longus tears and a review of the literature. Foot Ankle Spec. 2013;7:113–8.

    PubMed  Google Scholar 

  26. Diaz GC, van Holsbeeck M, Jacobson JA. Longitudinal split of the peroneus longus and peroneus brevis tendons with disruption of the superior peroneal retinaculum. J Ultrasound Med. 1998;17:525–9.

    CAS  PubMed  Google Scholar 

  27. Squires N, Myerson MS, Gamba C. Surgical treatment of peroneal tendon tears. Foot Ankle Clin. 2007;12:675–95.

    PubMed  Google Scholar 

  28. Stockton KG, Brodsky JW. Peroneus longus tears associated with pathology of the os peroneum. Foot Ankle Int. 2014;35:346–52.

    PubMed  Google Scholar 

  29. Wind WM, Rohrbacher BJ. Peroneus longus and brevis rupture in a collegiate athlete. Foot Ankle Int. 2001;22:140–3.

    CAS  PubMed  Google Scholar 

  30. Plastaras CT, Rittenberg JD, Rittenberg KE, Press J, Akuthota V. Comprehensive functional evaluation of the injured runner. Phys Med Rehabil Clin N Am. 2005;16:623–49.

    PubMed  Google Scholar 

  31. Macera CA. Lower extremity injuries in runners. Advances in prediction. Sports Med. 1992;13:50–7.

    CAS  PubMed  Google Scholar 

  32. Saupe N, Mengiardi B, Pfirrmann CWA, Vienne P, Seifert B, Zanetti M. Anatomic variants associated with peroneal tendon disorders: MR imaging findings in volunteers with asymptomatic ankles. Radiology. 2007;242:509–17.

    PubMed  Google Scholar 

  33. Galli MM, Protzman NM, Mandelker EM, Malhotra AD, Schwartz E, Brigido SA. An examination of anatomic variants and incidental peroneal tendon pathologic features: a comprehensive MRI review of asymptomatic lateral ankles. J Foot Ankle Surg. 2015;54:164–72.

    PubMed  Google Scholar 

  34. Park HJ, Cha SD, Kim HS, Chung ST, Park NH, Yoo JH, et al. Reliability of MRI findings of peroneal tendinopathy in patients with lateral chronic ankle instability. Clin Orthop Surg. 2010;2:237–43.

    PubMed  PubMed Central  Google Scholar 

  35. Giza E, Mak W, Wong SE, Roper G, Campanelli V, Hunter JC. A clinical and radiological study of peroneal tendon pathology. Foot Ankle Spec. 2013;6:417–21.

    PubMed  Google Scholar 

  36. Redfern D, Myerson M. The management of concomitant tears of the peroneus longus and brevis tendons. Foot Ankle Int. 2004;25:695–707.

    PubMed  Google Scholar 

  37. Davis WH, Mann RA. Principle of the physical examination of the foot and ankle. In: Coughlin MJ, Mann RA, Saltzman CL, editors. Surgery of the foot and ankle. 8th ed. Philadelphia: Mosby; 2007. p. 45–70.

    Google Scholar 

  38. Manoli A II, Graham B. The subtle cavus foot, “the underpronator,” a review. Foot Ankle Int. 2005;26:256–63.

    PubMed  Google Scholar 

  39. Brandes CB, Smith RW. Characterization of patients with primary peroneus longus tendinopathy: a review of twenty-two cases. Foot Ankle Int. 2000;21:462–8.

    CAS  PubMed  Google Scholar 

  40. Hodgkins CW, Kennedy JG, O’Loughlin PF. Tendon injuries in dance. Clin Sports Med. 2008;27:279–88.

    PubMed  Google Scholar 

  41. Coleman SS, Chestnut WM. A simple test for hindfoot flexibility in the cavovarus foot. Clin Orthop Relat Res. 1977;123:60–2.

    Google Scholar 

  42. Yewlett A, Oakley J, Makwana N, Patel HJ. Retained blackthorn causing peroneal tendonitis: a case report. Foot Ankle Surg. 2009;15:205–6.

    PubMed  Google Scholar 

  43. Sobel M, Geppert MJ, Olson EJ, Bohne WHO, Arnoczky SP. The dynamics of peroneus brevis tendon splits: a proposed mechanism, techniques of diagnosis, and classification of injury. Foot Ankle Int. 1992;13:413–22.

    CAS  Google Scholar 

  44. Geppert MJ, Sobel M, Bohne WHO. Lateral ankle instability as a cause of superior peroneal retinacular laxity: an anatomic and biomechanical study of cadaveric feet. Foot Ankle Int. 1993;14:330–4.

    CAS  Google Scholar 

  45. DiGiovanni BF, Fraga CJ, Cohen BE, Shereff MJ. Associated injuries found in chronic lateral ankle instability. Foot Ankle Int. 2000;21:809–15.

    CAS  PubMed  Google Scholar 

  46. Raikin SM, Elias I, Nazarian LN. Intrasheath subluxation of the peroneal tendons. J Bone Joint Surg Am. 2008;90:992–9.

    PubMed  Google Scholar 

  47. Vega J, Golano P, Batista JP, Malagelada F, Pellegrino A. Tendoscopic procedure associated with peroneal tendons. Tech Foot Ankle Surg. 2013;12:39–48.

    Google Scholar 

  48. Sarrafian SK. Osteology. In: Sarrafian SK, editor. Anatomy of the foot and ankle. Philadelphia: JB Lippincott; 1983. p. 35–106.

    Google Scholar 

  49. Pierson JL, Inglis AE. Stenosing tenosynovitis of the peroneus longus tendon associated with hypertrophy of the peroneal tubercle and an os peroneum. J Bone Joint Surg Am. 1992;74:440–2.

    CAS  PubMed  Google Scholar 

  50. Jennings J, Davies GJ. Treatment of cuboid syndrome secondary to lateral ankle sprains: a case series. J Orthop Sports Phys Ther. 2005;35:409–15.

    PubMed  Google Scholar 

  51. Marshall P, Hamilton WJ. Cuboid subluxation in ballet dancers. Am J Sports Med. 1992;20:169–75.

    CAS  PubMed  Google Scholar 

  52. Frey C, Feder KS, DiGiovanni C. Arthroscopic evaluation of the subtalar joint: does sinus tarsi syndrome exist? Foot Ankle Int. 1999;20:185–91.

    CAS  PubMed  Google Scholar 

  53. Molloy R, Tisdel C. Failed treatment of peroneal tendon injuries. Foot Ankle Clin. 2003;8:115–29.

    PubMed  Google Scholar 

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Correspondence to Mark J. Geppert .

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Geppert, M.J. (2020). History and Physical Examination in Peroneal Tendon Injury. In: Sobel, M. (eds) The Peroneal Tendons. Springer, Cham. https://doi.org/10.1007/978-3-030-46646-6_4

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  • DOI: https://doi.org/10.1007/978-3-030-46646-6_4

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