Peroneal Tendon Tear: Symptoms, Causes and Treatment

A peroneal tendon tear is an injury to one or both peroneal tendons, two cords of tissue that run along the outside of the ankle and help stabilize the foot. When one of these tendons splits or frays, the result is pain along the outer ankle, weakness and a foot that feels unsteady, especially on uneven ground. These tears are easy to overlook because they often travel with an ankle sprain and get blamed on the sprain alone.

Lingering pain on the outside of your ankle deserves a closer look. The board-certified and fellowship-trained foot and ankle specialists at Resurgens Orthopaedics diagnose and treat peroneal tendon tears at locations across metro Atlanta, with both nonsurgical and surgical options.

What You Need to Know About Peroneal Tendon Tears

What Are the Peroneal Tendons?

The peroneus longus and peroneus brevis start at the fibula in the lower leg and continue as tendons that run behind the bony bump on the outside of the ankle, the lateral malleolus. The peroneus brevis attaches to the fifth metatarsal at the base of the little toe, and the peroneus longus runs under the foot to connect on the inner side. Together they link the lower leg muscles to the foot, turning the foot outward and steadying the ankle when you change direction or push off. Because they sit on the outer edge of the ankle and take a sharp turn around the bone, they are vulnerable to stress, especially in people who repeatedly roll or twist that ankle.

What Causes a Peroneal Tendon Tear?

Peroneal tendon tears usually fall into two patterns based on how they develop:

Acute Tears From a Single Injury, Such as Rolling or Twisting the Ankle
Degenerative Tears That Develop Gradually as the Tendon Wears Down From Overuse

Several things raise the risk. Rolling the ankle is a common cause of sudden tears, and repeated ankle sprains can stretch and weaken the tendons over time. Athletes who run and jump at high intensity, run on uneven surfaces or wear worn-out footwear may also be more likely to develop a tear. A high arch may place extra strain on the peroneal tendons as well. Catching the problem early matters, since both sudden injuries and gradual overuse can worsen into a more serious tear if symptoms are ignored.

Peroneal Tendon Tear Symptoms

Symptoms tend to center on the outer side of the ankle and may come and go, particularly with degenerative tears. Common signs include:

Pain Along the Outside of the Ankle, Behind the Ankle Bone
Swelling in the Same Area
Weakness or a Sense That the Ankle May Give Way
Pain That Worsens With Activity and Eases With Rest
A Popping or Snapping Feeling at the Time of Injury

Please Note: Because a peroneal tendon tear so often accompanies an ankle sprain, outer-ankle pain that does not settle as expected after a sprain is worth having evaluated. A tear that is missed and left untreated can lead to ongoing ankle instability.

How a Peroneal Tendon Tear Is Diagnosed

Getting an accurate diagnosis starts with a visit to a foot and ankle specialist. Your physician will examine the ankle, ask about recent injuries and activity and check tenderness, swelling and range of motion. Testing the strength of the tendons by having you move the foot outward against resistance helps identify the problem, and pressing along the path of the tendons pinpoints the source of the pain. Imaging usually follows: an X-ray rules out a related fracture, while an MRI shows the soft tissue in detail and confirms whether a tendon is torn and how badly. Because these tears can hide behind ankle sprains, seeing a foot and ankle specialist gives you the best chance of catching the injury early.

Peroneal Tendon Tear Treatment Options

Treatment depends on the severity of the tear, your symptoms and how active you are. Most peroneal tendon tears are treated without surgery first, and surgery is considered when those measures do not relieve the pain or when the tear is severe.

Nonsurgical Treatment

Many tears respond well to conservative care that rests the tendon and calms the inflammation:

Rest and Reduced Activity to Take Stress Off the Tendon
A Cast, Boot or Brace to Let the Tendon Heal
Ice and Anti-Inflammatory Medication for Pain and Swelling
Physical Therapy to Rebuild Strength, Balance and Stability

Rehabilitation that focuses on balance and control is an important part of recovery. Strengthening the surrounding muscles helps protect the tendon and may lower the chance of another injury.

Surgical Treatment

When pain continues despite nonsurgical care, or the tear is large, your physician may recommend surgery. The specific procedure depends on the condition of the tendon. The surgeon may repair the torn tendon directly, remove damaged tissue or, when one tendon is too damaged to repair, join it to the neighboring tendon so the healthy one can do the work. If the tendons tend to slip out of place, the surgeon may deepen the groove behind the ankle bone to give them more room and keep them stable. Your Resurgens surgeon will explain which approach fits your injury and what recovery is likely to involve.

Peroneal Tendon Tear Recovery Time

Recovery depends on whether the tear was treated with rest and therapy or with surgery, and on the severity of the injury. Nonsurgical recovery often takes one to three months, while recovery after surgery usually takes several months and involves a period in a cast or boot followed by physical therapy to restore strength and motion. Returning to running, jumping or other high-impact activity too soon raises the risk of re-tearing, so it is worth waiting until your physician confirms the tendon has healed. Many people return to their usual activities once the tendon has healed and ankle strength is rebuilt.

Schedule an Appointment for Peroneal Tendon Care

If pain on the outside of your ankle is not going away, do not wait for it to worsen. Book an appointment online today with a Resurgens foot and ankle specialist or call us at (404) 847-9999.

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