Peroneal tendon disorders can be broadly categorised as – peroneal tendonitis, peroneal subluxations/dislocations and peroneal tendon tears – most often, injury to peroneal tendons occurs in conjunction with lateral ligamentous instability.
While discussing underlying biomechanical or structural abnormalities that increase stress and strain on the peroneal tendons, Cass et al. explain that foot types such as anterior cavus, forefoot valgus, a plantarflexed first ray, metatarsus adductus and rearfoot varus increase frictional forces at the lateral malleolus, peroneal tubercle and cuboid notch.
This results in increased mechanical stress and leads to higher incidences of peroneal tendon pathology since the tendons are put at a mechanical disadvantage caused by a reduction in their moment arm.
Regarding the association of peroneal tendon disorders with severe ankle sprains, ankle fractures and chronic ankle instability, the authors state that during inversion ankle injuries, the peroneus brevis tendon may become impinged between the peroneus longus and the fibular, leading to tears in the tendon.
Another commonly observed injury pattern in this regard is traumatic subluxation and dislocation of the peroneal tendons that is caused by disruption in the restraining tissues of these tendons.
Abnormalities of the retromalleolar sulcus can increase the predisposition of an individual to subluxations of the tendons from this groove, which may cause splits in the peroneus brevis as it subluxes around the posterolateral fibular border.
Pathologies of the peroneal tendon require an extensive knowledge of the anatomy of these tendons and associated structures; this gives the clinician a better understanding of the pattern of injury and helps in the development of successful preventative strategies.
Conservative measures involving decreased activity and various forms of immobilisation can be implemented early on in the treatment of peroneal tendon disorders to alleviate symptoms and prevent a surgical intervention.
The purpose of supportive foot devices is to reduce structural discrepancies and improve function to tissues such as the peroneal tendons by providing a supportive lateral force to the subtalar joint axis.
With the foot supported in its optimal posture, there is minimum stress placed on the peroneal tendons which are allowed sufficient recovery time and are able to function within their normal range of motion.
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Repetitive plantarflexion can lead to pain and mechanical limitation in the posterior ankle joint which is known as posterior ankle impingement syndrome. This pathology commonly occurs in ballet dancers and football players.