Peroneal Tendon Tears: Four Simple-to-Complex Cases

Peroneal tears are an important cause of lateral ankle pain and are often missed. Peroneal tears can present in different combinations requiring different surgical strategies. If the tears are symptomatic in patients in whom conservative treatment has failed, surgery is an option. We present the various types of surgical management of four patients, each with a different tear combination of the peroneal tendons. The first patient presented with a longitudinal split of the peroneal brevis tendon, which was repaired. The second patient had a tear of the peroneal longus tendon with a significant gap, while his peroneal brevis tendon was intact. His peroneal longus was tenodesed to the intact peroneal brevis. The third patient had ruptures of both his peroneal brevis and longus tendons with significant gaps. There was only a small peroneal brevis remnant left. The patient also had a cavovarus deformity of the same foot. His flexor hallucis longus tendon was harvested, routed, and sutured to the remnant peroneal brevis tendon. A lateralising calcaneal osteotomy and a dorsiflexion closing wedge osteotomy of his first metatarsal bone were also performed. The last patient had ruptures of both peroneal tendons with no remnant tendon remaining for repair. His anterior tibialis tendon was transferred from its insertion to his cuboid. A lateralising calcaneal osteotomy was performed, and an ankle-spanning external fixator was applied. A high index of suspicion for peroneal tears in lateral-sided ankle pain must be maintained. Peroneal tears can present in various combinations, with each combination requiring a different surgical treatment.