Peroneal Tendon Injury

Peroneal tendon injuries are a common but often overlooked source of lateral ankle pain and instability.

These injuries can range from chronic tendinopathy to acute tears or even complete rupture, affecting mobility and quality of life. Dr Daniel Meyerkort, a leading orthopaedic surgeon at Perth Orthopaedic & Sports Medicine, offers comprehensive care for peroneal tendon injuries, using state-of-the-art diagnostic and treatment strategies tailored to each patient.

In this article, we’ll explore the causes, symptoms, diagnosis, and management of peroneal tendon tears and ruptures, including both non-surgical and surgical approaches, with a focus on optimising outcomes and minimising recovery time.

Understanding Peroneal Tendons

The peroneal tendons consist of two major tendons—peroneus longus and peroneus brevis—that run behind the outer bone of the ankle (the fibula) and are responsible for stabilising the foot and ankle, particularly during walking and athletic movements. These tendons help prevent excessive inversion of the foot, playing a key role in ankle stability.

Causes of Peroneal Tendon Tears and Ruptures

Peroneal tendon injuries typically result from:

  • Chronic overuse, especially in athletes such as runners or dancers

  • Acute trauma, often due to ankle sprains

  • Repetitive ankle inversion injuries

  • Anatomical anomalies like a shallow peroneal groove or low-lying muscle belly

In some cases, these tendons can tear gradually (degenerative tears) or rupture suddenly due to a traumatic event.

Symptoms of Peroneal Tendon Injuries

Patients often present with:

  • Lateral ankle pain and swelling

  • Tenderness behind the fibula

  • A feeling of ankle instability or "giving way"

  • Clicking or snapping sensations over the outer ankle

  • Difficulty in weight-bearing or athletic activities

Diagnosis of Peroneal Tendon Tears

Dr Daniel Meyerkort conducts a thorough clinical examination and history review to identify signs of peroneal pathology. Imaging is crucial and may include:

  • MRI to visualise the tendons and assess the degree of tearing or rupture

  • Ultrasound for dynamic evaluation

  • X-rays to rule out fractures or osseous abnormalities

Early diagnosis is essential to avoid chronic complications such as tendon subluxation or ankle instability.

Non-Surgical Management of Peroneal Tendon Tears

Not all peroneal tendon injuries require surgery. Conservative treatment, especially for partial tears or tendinopathy, may include:

1. Activity Modification and Rest

Reducing high-impact activities or sports can help the tendons recover and prevent worsening of the tear.

2. Immobilisation

A CAM boot or ankle brace may be used for several weeks to offload the tendon and facilitate healing.

3. Physiotherapy

Guided rehabilitation programs focusing on proprioception, strengthening, and balance are key. Dr Meyerkort often works in conjunction with local physiotherapists in Perth to ensure coordinated care.

4. Anti-inflammatory Medications

NSAIDs or ice therapy may help manage pain and swelling.

5. Platelet-Rich Plasma (PRP) Injections

PRP therapy, performed at Perth Orthopaedic & Sports Medicine, is occasionally used to stimulate tendon healing in chronic tendinopathy.

 

While conservative management can be effective, persistent symptoms after 3-6 months may necessitate surgical intervention.

Surgical Management of Peroneal Tendon Tears and Ruptures

Surgical intervention is generally recommended for:

  • Full-thickness peroneal tendon tears

  • Tendon rupture with functional impairment

  • Tendon subluxation or instability

  • Failure of non-operative treatment

Dr Daniel Meyerkort specialises in minimally invasive and open techniques for tendon repair and stabilisation. Common procedures include:

1. Tendon Debridement and Repair

In cases of longitudinal or partial tears, the damaged tendon tissue is removed, and the healthy portions are sutured together.

2. Tenodesis

If one tendon is extensively damaged (commonly the peroneus brevis), it may be removed and attached to the healthier peroneus longus.

3. Peroneal Groove Deepening

To prevent tendon subluxation, the fibular groove may be surgically deepened and a retinaculum repair performed to stabilise the tendons.

4. Tendon Transfer

In rare, severe cases, tendon grafts or transfers may be used if both peroneal tendons are irreparable.

Postoperative Rehabilitation & Recovery

Following surgery, patients are typically placed in a non-weight-bearing cast or boot for 2–6 weeks, followed by a gradual return to weight-bearing with physiotherapy. A full return to sports can take 3–6 months, depending on the complexity of the procedure.

Dr Meyerkort uses evidence-based accelerated rehabilitation protocols to promote early recovery while reducing the risk of re-injury.

Benefits of Surgery

  • Restoration of ankle stability and function

  • Pain relief and improved mobility

  • Return to pre-injury level of activity or sport

  • Prevention of chronic instability or further tendon damage

Risks of Surgery

While generally safe, surgical treatment does carry risks, such as:

  • Infection

  • Nerve irritation or injury (especially the sural nerve)

  • Re-rupture or recurrent instability

  • Scar tissue formation

  • Delayed healing or stiffness

Dr Daniel Meyerkort carefully counsels each patient at Perth Orthopaedic & Sports Medicine to ensure they understand the risks and benefits before proceeding with surgery.

Why Choose Dr Daniel Meyerkort at Perth Orthopaedic & Sports Medicine?

Dr Meyerkort is a fellowship-trained orthopaedic surgeon with extensive experience in ankle surgery, particularly sports-related injuries. At Perth Orthopaedic & Sports Medicine, patients receive:

  • Personalised treatment plans

  • Advanced surgical techniques

  • Access to cutting-edge imaging and diagnostics

  • Coordinated care with physiotherapy and sports medicine

Patients across Perth and regional Western Australia can also access Telehealth consultations, enabling prompt diagnosis and management planning, even in remote locations.

Peroneal tendon tears and ruptures can be debilitating if left untreated. With timely diagnosis and expert management, patients can expect excellent outcomes. Whether you are an athlete or someone suffering from chronic ankle pain, Dr Daniel Meyerkort at Perth Orthopaedic & Sports Medicine offers comprehensive solutions—both non-surgical and surgical—to get you back on your feet.

Personalised Orthopaedic Care in Perth

If you're experiencing persistent lateral ankle pain or instability, book a consultation with Dr Meyerkort today to explore your treatment options.