Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Peroneus Tendon Rupture

SYMPTOMS

The patient presents with a history of sharp pain over the lateral posterior part of the ankle joint, often mistaken for a sprain. Sometimes the athlete refers to a ‘pop’ when the tendon ruptures or dislocates. Two snaps are typical for dislocationrepositioning.

AETIOLOGY

Peroneus tendon rupture is uncommon in young athletes but can occur if previous cortisone injections have weakened the tendon. A complete rupture is usually associated with degeneration in systemic diseases such as diabetes with arthropathy or after cortisone treatment. Usually one of the two tendons (brevis or longus) is intact, which makes the diagnosis even more difficult.

CLINICAL FINDINGS

There is tenderness on palpation over the peroneus retinaculum or along the peroneus tendon and weakness on a resistance test with active plantar flexion-inversion. Compare with the other ankle.

INVESTIGATIONS

MRI or ultrasound may show localised swelling and can often identify a rupture.

TREATMENT

In the acute phase RICE is advocated. Surgery is usually required to repair a ruptured tendon followed by eight to twelve weeks partial immobilisation.

REFERRALS

Refer to Dr Kevin Yip, orthopaedic surgeon for consideration of surgery.

EXERCISE PRESCRIPTION

Rest will not help so allow all kinds of sporting activities using well-fitting shoes and avoiding impact. A brace restricting plantar flexion and eversion-inversion can be used, allowing weight bearing but protecting the repair.

EVALUATION OF TREATMENT OUTCOMES

Monitor decrease of clinical symptoms and signs. Regained strength in plantar flexion-inversion and proprioception should be monitored. Compare with other ankle.

DIFFERENTIAL DIAGNOSES

Syndesmosis ligament tear (positive syndesmosis test), dislocation of peroneus tendons; MT V fracture or lateral malleoli fracture (positive X-ray).

PROGNOSIS

Excellent-Good, but the delay in diagnosis is often substantial leading to a long convalescence.

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