Patients suffer from lateral ankle pain. Swelling may also be present.

Can lead to chronic unstable ankle ( or may be the consequence !)

Ultrasound and MRI are required

Conservative Treatment : NSAIDs, activity restriction and a walking boot are often the first line of treatment

Surgical Treatment

• Core repair and tubularization of the tendon  

• debridement of the tendon + tenodesis of the brevis tendon to the peroneous longus

• debridement of both tendons with interposition allograft (complex tears with preserved muscle)

• debridement of both tendons with FHL transfer (complex tears with no muscle excursion)

• Hindfoot osteotomy or subtalar arthrodesis ( if hind foot varus deformity)

History :Patients often report they felt a pop with a dorsiflexion ankle injury

symptoms: clicking, popping and feelings of instability or pain on the lateral aspect of the ankle

physical exam:

• voluntary subluxation may be present.

• apprehension test: the sensation of apprehension or subluxation with active dorsiflexion and eversion against resistance cause subluxation/dislocation and apprehension

Xray is always needed. best done in internal rotation. should search for avulsion fracture and for hindfoot varus.

Ultrasound is interesting since it is dynamic exam and can show dislocation.

MRI

• best evaluated with axial views of a slightly flexed ankle

• can demonstrate anatomic anomalies leading to pathology

  • peroneus quartus muscle

  • low-lying peroneus brevis muscle belly

Surgery

• Short leg cast immobilization and protected weight bearing for 6 weeks (acute injury, especially if non-athelete). TENDONS MUST BE REDUCED

• Acute repair or reconstruction of superior peroneal retinaculum and deepening of the fibular groove