Overview
What are peroneal tendon syndromes?
What are acute injuries of the peroneal tendon?
What are chronic injuries of the peroneal tendon?
How are peroneal tendon syndromes diagnosed and managed?
What is the prevalence of peroneal tendon injuries in the US?
What is the functional anatomy relevant to understanding peroneal tendon syndromes?
What is the sport-specific biomechanics of peroneal tendon syndromes?
What is the role in biomechanics in determining the etiology of peroneal tendon damage?
What happens to the peroneal tendon when the core is destabilized?
Presentation
Which history is characteristic of peroneal tendonitis?
Which history is characteristic of peroneal tendon subluxation?
Which history is characteristic of peroneal tendon tears?
Which history is characteristic of anomalous peroneus brevis muscle injury?
Which history is characteristic of a lateral ankle impingement?
What should be the focus of the physical exam for a suspected peroneal tendon syndrome?
How is the ankle inspected and palpitated in the exam of a peroneal tendon injury?
What specific stability tests should be performed in the evaluation of peroneal tendon injury?
What is the role of a tilt test in the evaluation of peroneal tendon injury?
What is the role of a peroneal tendon stability test in the evaluation of peroneal tendon injury?
What are the possible etiologies of acute and chronic peroneal tendon injury?
Which biomechanical factors increase the risk for a peroneal tendon injury?
DDX
What are the differential diagnoses for Peroneal Tendon Syndromes?
Workup
What is the role of imaging studies in the evaluation of peroneal tendon injuries?
What is the role of electromyelography (EMG) in the evaluation of peroneal tendon injuries?
Treatment
What is the focus of management for chronic peroneal tendinopathy?
What is the focus of management for acute peroneal tendon injuries?
How is the acute phase of a peroneal tendon injury managed?
What is the role of surgery in the management of acute phase peroneal tendon injury?
What is the role of corticosteroids in the management of acute phase peroneal tendon injury?
What is the role of physical therapy in the recovery phase of peroneal tendon injury?
Why is proprioceptive rehabilitation needed during the recovery phase of peroneal tendon injury?
When is immobilization indicated in the recovery phase of peroneal tendon injury?
What is the role of regenerative biologic agents in the recovery phase of a peroneal tendon injury?
What is the role of percutaneous tenotomy in the recovery phase of a peroneal tendon injury?
What is the role of surgery during the recovery phase of a peroneal tendon injury?
What is the role of physical therapy in the maintenance phase of a peroneal tendon injury?
Medications
Which medications are used in the treatment of peroneal tendon syndromes?
Follow-up
When should a patient return to regular activity after a peroneal tendon injury?
What are possible complications of peroneal tendon injury treatment?
How are peroneal tendon injuries prevented?
What is the prognosis of peroneal tendon injury?
What education about peroneal tendon injury should patients receive?
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Lateral ankle anatomy demonstrates the peroneal tendons as they course beneath the superior retinaculum. The anterior talofibular, calcaneofibular, and posterior talofibular ligaments are also shown.
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Anterior drawer test, which assesses anterior talofibular ligament stability. The top hand stabilizes, while the lower hand translates the calcaneus and talus directly toward the operator. From Karageanes SJ. Principles of Manual Sports Medicine, Lippincott Williams & Wilkins, 2005.
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Tilt test. The operator tilts the talus and calcaneus, not the forefoot. This assesses the integrity of the calcaneofibular ligament. From Karageanes SJ. Principles of Manual Sports Medicine, Lippincott Williams & Wilkins, 2005.
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Dislocated peroneal tendons. Left, Note the course of the tendons anterior to the lateral malleolus. Right, Image demonstrates manual relocation of the displaced tendons.
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Peroneal stability test. The patient pushes the foot laterally against resistance, while the operator monitors the tendon. From Karageanes SJ. Principles of Manual Sports Medicine, Lippincott Williams & Wilkins, 2005.