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Peroneal Tendonitis and Tears of the Ankle

The peroneal tendons are the tendons that connect the muscles of the outer side of the calf to the foot. The two major peroneal muscles (peroneus longus and peroneus brevis) are situated on the outside of the leg, just adjacent to the calf muscles. The muscles are connected to bone by the tendons which run along the outer side of the ankle and attach to the foot.

The peroneal muscles are important for turning the foot.   In normal gait, the motion of the peroneal muscles is balanced by the muscles that invert the foot (rock the foot inward from the ankle).​

The two peroneal tendons are very closely related  and they sit one on top of the other right behind the fibula. This close relationship is thought to contribute to some of the problems that occur to the peroneal tendons, as they rub together behind the ankle.

The most common problem that occurs with the peroneal tendons is inflammation or tendonitis and the tendons are usually inflamed just behind the fibula bone at the ankle joint. This part of the fibula is the bump on the outside of the ankle (also referred to as the lateral malleolus), and the peroneal tendons are located just behind that bony prominence.

Peroneal tendonitis can either be the result of repetitive overuse or an acute injury with symptoms of  with typical symptoms of peroneal tendonitis including pain behind the ankle, swelling over the peroneal tendons, and tenderness of the tendons. Pain is usually worsened if the foot is pulled down and inwards, stretching the peroneal tendons. X-rays of the ankle are typically normal, and an MRI may show inflammation and fluid around the tendons.

Peroneal Tears

Tears of the peroneal tendons are unusual, and almost always occur to the peroneus brevis tendon. Tears are thought to be the result of two issues with the tendon. One issue is the blood supply. and the second, is the close relationship of the two tendons, causing the peroneus brevis to be wedged between the peroneus longus tendon and the bone.

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