Acute Peroneal Tendon Injuries in Sport

Peroneal tendon pathology is a common and underdiagnosed cause of lateral ankle pain. Acute injuries may occur in sport, but often go unrecognized at the initial time of injury. It is not uncommon for patients to experience a considerable delay before diagnosis of peroneal tendon injury. The anatomy of the peroneal tendons predisposes to acute injury via the same injury mechanisms that cause lateral ankle ligamentous injury. Acute peroneal instability typically occurs secondary to rapid ankle dorsiflexion and eversion. Chronic peroneal instability is often associated with recurrent lateral ankle instability. Repetitive instability may lead to peroneal tendon pathology, including longitudinal tears. Patients frequently complain of lateral ankle pain, with an insidious and gradual onset of pain, and symptoms are frequently the result of tendon instability, due to superior peroneal retinaculum injury. Treatment is frequently nonsurgical with initial immobilization, followed by gradual return to activity, including progressive motion, strengthening, and proprioceptive stability exercises. Failure of nonsurgical management may indicate surgical treatment, including tendon and instability repair. Surgical treatment has a greater than 90% success rate, with elimination of instability, relief of symptoms, return of function, and return to activities.