Who Should Consider Getting Peroneal Tendon Surgery?

Peroneal tendon surgery is generally effective and carries a low likelihood of serious complications when advised by a physician for individuals who are otherwise healthy.

Peroneal tendon surgery repairs one of the tendons belonging to the peroneal (fibularis) muscles. A tendon is the connective tissue that links a muscle to bone.

The peroneal muscles lie along the outside of the lower leg and assist with ankle movement and stability. All three peroneal muscles insert on the lateral side of the foot, but each originates from a different portion of the leg:

• Peroneus longus attaches to the upper fibula just beneath the knee.
• Peroneus brevis originates from the middle portion of the fibula.
• Peroneus tertius comes from the lower fibula just above the ankle.

Peroneal tendons can be injured by acute trauma or repetitive strain. Runners and other athletes who put repeated stress on the ankle are particularly prone to these injuries.

Below is an overview of peroneal tendon surgery, including potential complications, success rates, and typical recovery timelines.

Does peroneal tendon surgery work?

Surgery can be an effective option for peroneal tendon injuries that haven’t improved with nonoperative measures.

For instance, a 2016 study  reported that 83.1% of 201 patients who underwent repair of a torn peroneus brevis between 2008 and 2012 had returned to regular exercise and sports at one year after surgery.

Surgeons employ several techniques to address peroneal tendon problems. Common approaches include:

• Tendon debridement and synovectomy: An incision is made to remove degenerated or inflamed tissue and the damaged tendon sheath. This is often used for tendonitis .
• Tendon debridement and tubularization: The damaged portion of the tendon is excised and the remaining tissue is sutured to restore structure. This is used for partial tendon tears.
• Arthroscopic peroneal tendoscopy: A camera-equipped tube is introduced into the tendon sheath and instruments are used to remove damaged tissue. Most studies  show good to excellent outcomes with few complications.
• Endoscopic retinaculum repair: If the retinaculum (the tissue that keeps the tendons in place) is damaged and allows tendons to shift, it can be repaired using endoscopic techniques.
• Allograft or autograft reconstruction: Tendon reconstruction may use the patient’s own tissue (autograft) or donor tissue (allograft) to restore continuity.
• Peroneal tenodesis: The damaged segment is removed and the remaining tendon ends are sutured together.

What are the risks and side effects of peroneal tendon surgery

Peroneal tendon procedures are typically safe with a relatively low complication rate. A 2022 review  documented a 38.7% complication rate among 336 patients who underwent five different types of peroneal tendon surgeries.

The most frequent issue is numbness of the skin due to injury to branches of the sural nerve.

Other possible complications include:

• damage to nerves, arteries, or veins
• scarring
• persistent swelling
• bleeding
• recurrent tendon tears
• slow wound healing
• tendon degeneration
• reduced range of motion
• infection
• ongoing pain

Who is a candidate for peroneal tendon surgery

Suitable candidates are those whose peroneal tendon injury has not responded to nonoperative therapies and who are medically fit for surgery.

Physicians typically advise trying conservative measures for at least 4 to 8 weeks before opting for surgery, although some clinicians may recommend a longer trial.

When is peroneal tendon surgery necessary?

Surgery may be required when peroneal tendon injuries fail to improve with conservative care. These injuries most commonly affect young, active people , particularly athletes involved in activities that repeatedly stress the ankle, such as running.

Conditions that may need surgical repair include:

• Peroneal tendonitis: Inflammation of a peroneal tendon caused by acute trauma or repetitive overuse.
• Peroneal subluxation: One or more tendons slipping out of their normal position.
• Peroneal tendon tear: Tears may be tiny or complete ruptures, with the majority resulting from chronic overload.

What happens if you don’t repair a torn peroneal tendon?

Peroneal muscles play a critical role in ankle stability. If left untreated, peroneal tendon injuries can lead to ankle instability and a higher chance of sprains.

Prompt treatment can help prevent progression to more severe damage, such as full-thickness tendon ruptures.

Can a torn peroneal tendon heal on its own?

Mild to moderate peroneal tendon injuries often recover without surgery. Your clinician will advise whether surgery is necessary based on factors such as:

• severity and type of the injury
• duration of symptoms
• your activity level

Are there any alternatives to peroneal tendon surgery?

Surgery is typically reserved for cases that haven’t improved with conservative care. Doctors may suggest nonoperative treatments for at least 4 to 8 weeks, and sometimes longer, including:

• physiotherapy
• bracing
• anti-inflammatory medications
• avoiding activities that provoke pain or risk reinjury
• strengthening exercises
• weight reduction

Using the PRICE approach can also support recovery. This stands for:

• Protection
• Rest
• Ice
• Compression
• Elevation

How long after peroneal tendon surgery can you walk?

Most surgeons advise avoiding weight-bearing for approximately 2 to 6 weeks after surgery, depending on the complexity of the procedure. There is a trend toward initiating early range-of-motion and rehab exercises within 4 weeks . Return to athletic activities is commonly permitted after 4 to 6 months .

A 2016 review  suggested this typical postoperative schedule after peroneal tendon repair:

Always adhere to your surgeon’s specific instructions for recovery.

Takeaway

Peroneal tendons can be injured by sudden trauma or repetitive stress to the ankle. If conservative treatments don’t relieve your symptoms, your doctor may suggest surgery.

Surgery often successfully treats these injuries with a relatively low rate of adverse effects. The exact surgical approach depends on the nature of the tendon problem.