Skip to content

Clinicians › Ankle

Peroneal tendon disorders

31 citationsUpdated Sep 2026

Overview

Symptomatic peroneal tendon injuries arise from both acute and chronic processes [1]. Peroneal tenosynovitis is rarely reported and frequently misdiagnosed, often following an inversion injury of the ankle [6]. Peroneal tendinosis and peroneal subluxation are uncommon but lifestyle-limiting conditions that worsen if not properly diagnosed and treated [2]. A deficiency in the viscoelastic properties of the peroneus longus tendon must be considered in the diagnostic and treatment of ankle instability [12]. All patients with peroneal tendon tears had associated intra-articular pathology, with the majority having more than one lesion [10]. Description of distal peroneal tendon dislocations remains limited in the literature [16]. The ESSKA-AFAS consensus statement on the optimal management of peroneal tendon pathologies is the result of international and multidisciplinary agreement combined with a systematic review of the literature [5].

Peroneal tendoscopy is a safe and effective minimally invasive technique for managing peroneal tendon disorders, associated with significant short-term improvement in clinical outcomes and low complication and failure rates [9]. It is an effective and minimal invasive management tool that can be indicated in many peroneal disorders [4]. Studies report good clinical outcomes in patients with peroneal tendon disorders treated with peroneal tendoscopy [8, 11]. However, on the basis of current literature, there is poor evidence (grade Cf) in support of Achilles, flexor hallucis longus, and peroneal tendoscopy for the common indications [3]. Further studies are needed and planned to evaluate clinical outcomes after IONT of the peroneal tendons [13].

For recurrent peroneal tendon dislocation, both reattachment of the superior peroneal retinaculum and the bone block procedure offered satisfactory results with low rates of recurrence and complications [14]. Soft tissue procedures offer a satisfactory method of treating peroneal tendon dislocations without any additional risk of reoperation when compared to osteotomy techniques that have potentially greater complication rates [15]. Endoscopic stabilisation of peroneal tendons in a child with open physes gives good functional outcomes without growth plate disturbance [17].

Anatomy & Pathophysiology

Bony and Soft Tissue Anatomy

The peroneus longus and peroneus brevis tendons originate from the fibula and interosseous membrane and are innervated by the superficial peroneal nerve (S1) [27]. The peroneus brevis originates from the distal half of the lateral fibula, while the peroneus longus originates more proximally on the lateral fibula [51]. Both tendons run within the peroneal groove, a sulcus formed posteriorly in the fibula that is stabilized by a fibrocartilaginous rim and the superior peroneal retinaculum (SPR) [27]. Within this retromalleolar sulcus, the peroneus brevis is positioned anterior and medial to the peroneus longus [27, 51]. The low-lying muscle belly of the peroneus brevis typically terminates approximately 3 cm from the tip of the fibula [51].

Both tendons curve anteriorly around the tip of the fibula, with the peroneal tubercle separating them at the level of the calcaneus [27]. The peroneus brevis inserts onto the tuberosity of the fifth metatarsal [27, 51]. The peroneus longus makes a 90° turn medially at the cuboid groove before inserting into the base of the first metatarsal and medial cuneiform [27, 51]. The SPR runs from the posterolateral ridge of the fibula to the lateral calcaneus and functions as the primary restraint to peroneal tendon subluxation within the retromalleolar sulcus [51]. The retromalleolar sulcus is deepened by a fibrocartilaginous rim, providing moderate inherent stability to the tendons [51].

The primary function of the peroneal tendons, particularly the peroneus brevis, is to evert the hindfoot [27]. Secondarily, the peroneal tendons plantarflex the ankle, and the peroneus longus plantarflexes (pronates) the first ray [27]. The peroneal tendons also provide supplemental lateral ankle stability [51]. A vascular watershed region just posterior to the fibula is the most common area of injury for the peroneal tendons [27].

Anatomic Variations

Anatomic variations of the peroneus brevis tendon are classified into three main types based on attachment to the calcaneus, the cuboid, or the peroneus longus tendon [24]. The peroneocalcaneal variant is the most common anatomical variation and has been classified into six subtypes [24]. The most common anomaly of the peroneus brevis is an additional tendinous slip, without anomalous muscle tissue, that passes through the peroneus tertius and inserts either on the long extensor of the fifth toe at the proximal phalanx or on the shaft of the fifth metatarsal [24]. LeDouble found a well-developed peroneus brevis slip in 22% of cadavera and a vestigial one in an additional 13% [24]. A low-lying peroneus brevis muscle belly is an anatomic variation implicated in tendon tears and instability [27]. The presence of a peroneus quartus muscle, found in 13% to 22% of individuals, may be seen in the fibular groove and contributes to crowding of the fibro-osseous tunnel [27].

Pathophysiology and Mechanisms of Injury

Peroneal tendon injury occurs when there is rapid dorsiflexion of the inverted foot [51]. This mechanism causes reflexive contraction of the peroneus brevis and longus, which can lead to frank tendon injury or injury to the superior peroneal retinaculum (SPR) [51]. Dislocation or subluxation occurs during an inversion injury to a dorsiflexed ankle with rapid reflexive contraction of the peroneus longus and peroneus brevis tendons [27]. This results in a disruption of the superior peroneal retinaculum (SPR) or fibrocartilage ridge [27]. Patients with dislocation or subluxation describe a “pop” or snapping sensation, followed by pain and swelling [27].

Anatomic studies have demonstrated that the peroneal tendons are perched along the distal fibula at 15° to 25° of plantar flexion, making them susceptible to inversion injury at this position [51]. Peroneal tendon tears can occur in the 25–15° range of plantar flexion as the peroneus longus impinges against the tip of the fibula and as the peroneus brevis impinges against the lateral wall of the peroneal groove [18]. Cadaveric studies suggest that the splitting of the peroneal tendon develops through a mechanical mechanism with the central portion of the longitudinal split centered over the distal tip of the fibula in the fibular groove [18]. Longitudinal split tears of the peroneus brevis are usually found within the retromalleolar sulcus, indicating they are likely due to mechanical trauma in this region [18].

Contributing factors to peroneal tendon tears include overcrowding of the peroneal groove, instability of the superior peroneal retinaculum, lateral ankle instability, contraction of the peroneus longus, hypovascularity of the peroneus brevis tendon, and a shallow peroneal groove of the fibula [18]. A shallow peroneal groove and overcrowding of the fibular groove are predisposing factors for dislocation or subluxation [27]. Compression from the peroneus longus on the peroneus brevis is implicated in injury within the vascular watershed region [27]. Etiologic factors for tendon tears include compression of the peroneus brevis between the peroneus longus tendon and the posterior fibula, subluxation/dislocation of the tendons, diminished blood supply in the watershed region, acute change in direction around the fibula, and ankle instability or varus heel [27].

Peroneal tendon tears are frequently associated with peroneal tendon instability with subluxing peroneal tendons impinged by a sharp posterior ridge of the fibula [18]. In cases in which the SPR is disrupted, the peroneal tendons will subluxate repeatedly, which often leads to longitudinal tears, most frequently in the peroneus brevis where it runs within the fibular groove [51]. Chronic symptoms can develop when the peroneal tendons are not anatomically located in their retromalleolar position and subsequently subluxate abnormally with ankle motion [51]. Peroneal tendon pathology often is observed in the setting of lateral ankle ligamentous instability [51]. There is a correlation between peroneal tendinosis and ankle sprain trauma, with ligament injuries associated with further complications [19]. Peroneal tendon tears without tendon subluxation are not common, especially in young people, and may be overlooked [18].

Most tendon tears occur in the peroneus brevis tendon, at the level of the fibular groove [27]. Less common are tears of the peroneus longus tendon, which usually occur at the peroneal tubercle [27]. Peroneus brevis and peroneus longus tendon tears are often longitudinal in the tendon and typically are seen in chronic situations [27]. Acute longitudinal tendon tears may also occur in the setting of dislocation or subluxation [27]. Tears may be the result of inversion injuries or injury causing tendon subluxation or dislocation [27]. Acute tendinitis may result from overuse, predisposition from a varus hindfoot, or stenosis within the peroneal tunnel from a peroneus quartus muscle or low-lying PB muscle belly [27].

Classification

Peroneus Brevis Anatomical Variations: Anatomical variations of the peroneus brevis tendon are classified into three main types based on attachment to the calcaneus, the cuboid, or the peroneus longus tendon [24]. In Type II anomalies, the tendon originates more distally on the muscle belly of the peroneus brevis [24]. Type III anomalies involve a tendon that inserts more proximally on the calcaneus [24]. Type V anomalies are characterized by a tendon originating from the distal third of the peroneus brevis and dividing into three slips that insert on the lateral aspect of the calcaneus posterior to the inferior peroneal retinaculum [24]. In Type VI anomalies, the peroneus brevis presents with three separate muscle bellies and tendons [24]. LeDouble identified a well-developed slip in 22 percent of cadavera and a vestigial one in an additional 13 percent [24].

Other Considerations: Longitudinal split tears of the peroneus brevis are usually found within the retromalleolar sulcus [18]. Peroneal tendon tears without tendon subluxation are not common, especially in young people [18]. Detachment of the inferior peroneal retinaculum, peroneus longus tendon dislocation, and entrapment by a split lesion represent a new complex entity [32].

Clinical Presentation

General Characteristics

Refractory pain on the posterolateral aspect of the ankle warrants consideration of a peroneal tendon tear [18].

Acute Tendinitis

Patients with acute tendinitis report swelling and pain in the lateral hindfoot or ankle [27]. Physical examination reveals swelling and pain with palpation, and may reveal reduced strength [27]. MRI demonstrates fluid within the peroneal tendon sheath in these cases [27].

Tendon Tears or Ruptures

Symptoms of tendon tears are similar to those of tendinitis [27]. Physical examination results are also similar to tendinitis, but subluxation or dislocation may be provoked during examination with eversion against resistance [27]. MRI reveals longitudinal tears in the tendon, although these can be confused with a peroneus quartus muscle [27]. A patient with complete rupture presents with severe limitation of eversion strength [27].

Dislocation or Subluxation

Physical examination for dislocation or subluxation reveals variable pain and swelling depending on the acuteness of the injury [27]. Dislocation or subluxation may be elicited with ankle rotation or with forcing the foot from a position of inversion and plantar flexion to a position of eversion and dorsiflexion [27]. Radiographs may reveal an avulsion fracture of the distal fibula (rim fracture) at the insertion of the superior peroneal retinaculum in cases of dislocation or subluxation [27]. The diagnosis of dislocation or subluxation is clinical, and additional studies are often not needed [27].

Investigations

Plain radiography: Plain radiographs are usually negative in peroneal tendon subluxation, though a "fleck" of bone may be seen off the posterior distal fibula in grade 3 injury [42]. In cases of subluxation, radiographs may demonstrate a rim fracture of the lateral aspect of the distal fibula [27, 40, 41]. An avulsion fracture of the distal fibula at the insertion of the superior peroneal retinaculum may also be revealed [27]. In acute rupture of the peroneus longus tendon at or through a fracture of the os peroneum, radiographs show retraction or fracture of the os peroneum [40, 41].

MRI: MRI reveals longitudinal tears in the peroneal tendon, which can be confused with a peroneus quartus muscle [27]. False-positive results showing longitudinal tears are common with MRI [40, 41]. MRI may demonstrate displacement of peroneal tendons anterolateral to the retrofibular region [40, 41]. It can be used to identify injury to the superior peroneal retinaculum [42] and anomalous structures such as the peroneus quartus or a low-lying peroneal brevis muscle belly [42]. Kinematic MRI of the ankle moving from dorsiflexion to plantar flexion has been suggested to be superior to static imaging because the pathologic process is position dependent [42].

Ultrasound: Ultrasound is useful as a dynamic tool to evaluate peroneal tendon subluxation or dislocation [40, 41]. Ultrasonography has been reported to be effective for dynamically evaluating peroneal tendon subluxation [42].

Other Considerations: Peroneal tenosynovitis is frequently misdiagnosed, often following inversion injury of the ankle [6]. Longitudinal split tears of the peroneus brevis are usually found within the retromalleolar sulcus, indicating that they are likely due to mechanical trauma in this region [18]. The splitting of the peroneal tendon develops through a mechanical mechanism with the central portion of the longitudinal split centered over the distal tip of the fibula in the fibular groove [18]. The tear of the peroneal tendon could occur in the 25–15° range of plantar flexion as the peroneus longus impinged against the tip of the fibula and as the peroneus brevis impinged against the lateral wall of the peroneal groove [18]. Peroneal tendinosis is correlated with ankle sprain trauma, with ligament injuries associated with further complications [19]. About 20% of athletes referred for MRI after suffering an acute ankle sprain had evidence of a syndesmotic injury regardless of lateral ligament involvement [33]. More than half of athletes referred for MRI after suffering an acute ankle sprain had evidence of any lateral ligament injury without syndesmotic involvement [33].

Treatment

Non-Operative

Chronic peroneal tendinosis or tenosynovitis is initially managed with activity modification, NSAIDs, a lace-up ankle brace, and physical therapy [40]. For localized inflammation and tendinitis at the peroneus longus tendon associated with the os peroneum, prolonged immobilization in a cast and oral anti-inflammatory medication are recommended [54].

Operative

Indications: Surgery is indicated for peroneal tendon pathology when degenerative tears, usually affecting the peroneus brevis, require tenosynovectomy, débridement, and repair [40]. Early treatment of longitudinal splits is necessary to reduce the risk of progression to a full tear [40]. Excision and tenodesis are required when there is a complete rupture or a severely degenerative tendon (>50%) that prohibits repair [40]. Chronic peroneal subluxation or dislocation requires repair or reconstruction of the superior peroneal retinaculum (SPR) and fibular groove deepening [40]. Acute peroneal subluxation or dislocation requires SPR repair or reconstruction [40]. Debridement of the peroneus longus tendon, removal of the os peroneum, and tenodesis of the peroneus longus to the peroneus brevis may be indicated for chronic reproducible tenderness in the plantar-lateral aspect of the lateral midfoot despite conservative treatment [54].

Surgical Approach / Technique: In the setting of degeneration to both the peroneus longus and brevis, there must be excursion of the proximal muscle belly of either the longus or brevis [40]. If there is no viability of the proximal musculature, a tendon transfer of the flexor hallucis longus (FHL) is a salvage operation that can restore some active function without expectation of normal function [40]. More than 50% degeneration of both the peroneus longus and brevis requires excision of both tendons [40]. Good results have been reported with lateral transfer of the FHL or flexor digitorum longus (FDL) and with allografts for peroneal tendon defects [40]. Allograft may be used if peroneal muscles demonstrate adequate excursion at the time of surgery with minimal atrophic change to the muscle [40]. In the younger, more active patient population, the use of an allograft reconstruction can be considered [40]. For hindfoot varus, a Dwyer osteotomy (lateral closed-wedge osteotomy of the calcaneus) limits the risk of recurrent tears and continued pain [40]. Groove deepening is indicated if there is a shallow fibular groove, and peroneal retinacular repair is indicated if there is evidence of tendon subluxation [40]. Assessment for intratendinous subluxation is also needed in the management of peroneal tendon disorders [40]. Both reattachment of the superior peroneal retinaculum and the bone block procedure offer satisfactory results for recurrent peroneal tendon dislocation with low rates of recurrence and complications [14]. If the cuboid tunnel is constricted during os peroneum surgery, it may be enlarged with a small osteotome and rasp, using bone wax to cover exposed cancellous surfaces [54].

Adjuncts: A study found good clinical outcomes in patients with peroneal tendon disorders treated with peroneal tendoscopy [8]. Tendoscopy of the peroneal tendons is an effective and minimal invasive management tool that can be indicated in many peroneal disorders [4]. On the basis of current literature, there is poor evidence (grade Cf) in support of peroneal tendoscopy for common indications [3]. Operative results were uniformly good in patients with retrofibular pain treated with endoscopic management, regardless of whether tendon tears, tenosynovitis, or neither were present [18].

Postoperative Care: Postoperative care for os peroneum surgery involves a non-weight-bearing cast for 4 weeks, followed by protected weight bearing in a walking boot, with formal physical therapy started at 8 weeks after surgery [54].

Complications

Tendon Tear: Peroneal tendon tears can occur in the 25–15° range of plantar flexion. This mechanism involves the peroneus longus impinging against the tip of the fibula and the peroneus brevis impinging against the lateral wall of the peroneal groove or against the [18].

Surgical Complications: Osteotomy techniques for peroneal tendon dislocations carry potentially greater complication rates compared to soft tissue procedures [15].

Other Considerations: Approximately one-quarter of patients treated with the modified Broström procedure for chronic lateral ankle instability experienced recurrent sprains [35]. Nearly half of the cohort treated with the modified Broström procedure was not able to achieve their previous sports performance, particularly athletes and those with calcaneofibular ligament injuries [35].

Recovery

Other Considerations: Both surgical procedures for recurrent peroneal tendon dislocation yield satisfactory results, characterized by low rates of recurrence and complications [14]. Long-term stability is durable; at fourteen years post-procedure, patients maintain a stable, painless ankle with no additional instability [25]. The tendoscopic approach is less invasive and can accelerate return to sports, though it requires longer operation time and is more technically demanding [46]. Preoperative counseling should incorporate tangible data on the expectable time frame for individual return to sports and work trajectories to manage patient expectations regarding sports- and work-related outcomes [71]. Approximately one-quarter of patients experience recurrent sprains, and nearly half of the cohort are unable to achieve their previous sports performance, particularly among athletes and those with calcaneofibular ligament injuries [35].

Key Evidence

  • [Paper] Symptomatic peroneal tendon injuries can result from both acute and chronic processes. [1] (10.1016/j.csm.2015.06.003)
  • [L5] Peroneal tendinosis and peroneal subluxation are uncommon but lifestyle-limiting conditions that worsen if not properly diagnosed and treated. [2] (10.1016/j.csm.2020.07.005)
  • [L4] On the basis of the current literature available, there is poor evidence (grade Cf) in support of Achilles, flexor hallucis longus, and peroneal tendoscopy for the common indications. [3] (10.1016/j.arthro.2014.02.022)
  • [L4] Tendoscopy of the peroneal tendons is an effective and minimal invasive management tool that can be indicated in many of peroneal disorders. [4] (10.1007/s00167-006-0227-2)
  • [L5] This ESSKA-AFAS consensus statement on the optimal management of peroneal tendon pathologies is the result of international and multidisciplinary agreement combined with a systematic review of the literature. [5] (10.1007/s00167-018-4971-x)
  • [L4] Peroneal tenosynovitis is rarely reported and frequently misdiagnosed, often following inversion injury of the ankle. [6] (10.1016/s0020-1383(01)00051-1)
  • [L4] The study found good clinical outcomes in patients with peroneal tendon disorders treated with peroneal tendoscopy. [8] (10.1007/s00167-016-4012-6)
  • [L4] Peroneal tendoscopy is a safe and effective minimally invasive technique for managing peroneal tendon disorders, associated with significant short-term improvement in clinical outcomes and low complication and failure rates. [9] (10.1177/2325967126s00423)
  • [L4] All patients with peroneal tendon tears had associated intra-articular pathology, with the majority having more than one lesion. [10] (10.1016/j.arthro.2009.05.010)
  • [L4] Peroneal tendoscopy provides good outcomes in the treatment of peroneal tendon pathologies. [11] (10.1016/j.arthro.2016.03.081)
  • [L5] A deficiency in viscoelastic properties of the peroneus longus tendon must be considered in diagnostic and treatment for ankle instability. [12] (10.1007/s00167-012-2273-2)
  • [L5] Further studies are needed and planned to evaluate clinical outcomes after IONT of the peroneal tendons. [13] (10.1016/j.eats.2021.11.002)
  • [L3] Both procedures offered satisfactory results for recurrent peroneal tendon dislocation with low rates of recurrence and complications. [14] (10.1007/s00167-019-05479-2)
  • [L3] Soft tissue procedures offer a satisfactory method of treating peroneal tendon dislocations without any additional risk of reoperation when compared to osteotomy techniques that have potentially greater complication rates. [15] (10.1007/s00167-016-4383-8)
  • [L4] Description of distal peroneal tendon dislocations is limited in the literature. [16] (10.1016/s0020-1383(13)70202-x)
  • [L4] Endoscopic stabilisation of peroneal tendons in a child with open physes gives good functional outcomes without growth plate disturbance. [17] (10.1007/s00167-016-4210-2)
  • [L4] [18] (10.1007/s00402-011-1392-4)
  • [L4] The results reflect the correlation between peroneal tendinosis and ankle sprain trauma, with ligament injuries associated with further complications. [19] (10.1007/s00167-015-3562-3)
  • [L4] Fourteen years post-procedure, the patient maintained a stable, painless ankle with no additional instability. [25] (10.1097/01.blo.0000092976.12414.b0)
  • [Case_report] Detachment of the inferior peroneal retinaculum, peroneus longus tendon dislocation, and entrapment by a split lesion represent a new complex entity that can effectively be reconstructed by partial resection of the split tendon, groove deepening, and transosseous reinsertion of the inferior peroneal retinaculum. [32] (10.1186/s12891-020-03757-6)
  • [L3] About 20% of athletes referred for MRI after suffering an acute ankle sprain had evidence of a syndesmotic injury regardless of lateral ligament involvement, while more than half had evidence of any lateral ligament injury without syndesmotic involvement. [33] (10.1177/0363546514529643)
  • [L4] However, approximately one-quarter experienced recurrent sprains, and nearly half of the cohort was not able to achieve their previous sports performance, particularly athletes and those with calcaneofibular ligament injuries. [35] (10.1177/03635465251354961)
  • [L3] This tendoscopic procedure needs longer operation time and is more technically demanding, but it is a useful procedure, because it is less invasive and can accelerate return to sports. [46] (10.1007/s00167-020-05877-x)
  • [L4] These results may be helpful in preoperatively managing patients' expectations regarding sports- and work-related outcomes and provide tangible data on the expectable time frame of the individual return to sports and work trajectory. [71] (10.1007/s00167-022-06937-0)

See Also

References

[1] Peroneal Tendon Disorders. Clinics in Sports Medicine. 2015. DOI: 10.1016/j.csm.2015.06.003

[2] Peroneal Tendinosis and Subluxation. Clinics in Sports Medicine. 2020. DOI: 10.1016/j.csm.2020.07.005

[3] Foot and Ankle Tendoscopy: Evidence‐Based Recommendations. Arthroscopy. 2014. DOI: 10.1016/j.arthro.2014.02.022

[4] Tendoscopic management of peroneal tendon disorders. Knee Surgery, Sports Traumatology, Arthroscopy. 2006. DOI: 10.1007/s00167-006-0227-2

[5] The ESSKA-AFAS international consensus statement on peroneal tendon pathologies. Knee Surgery, Sports Traumatology, Arthroscopy. 2018. DOI: 10.1007/s00167-018-4971-x

[6] Peroneal tenosynovitis following ankle sprains. Injury. 2001. DOI: 10.1016/s0020-1383(01)00051-1

[8] Functional outcomes after peroneal tendoscopy in the treatment of peroneal tendon disorders. Knee Surgery, Sports Traumatology, Arthroscopy. 2016. DOI: 10.1007/s00167-016-4012-6

[9] Poster 119. Clinical Outcomes of Peroneal Tendoscopy for Peroneal Tendon Disorders: A Systematic Review. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/2325967126s00423

[10] Peroneal Tendon Tears: Associated Arthroscopic Findings and Results After Repair. Arthroscopy. 2009. DOI: 10.1016/j.arthro.2009.05.010

[11] Functional Outcomes of Peroneal Tendoscopy in the Treatment of Peroneal Tendon Disorders. Arthroscopy. 2016. DOI: 10.1016/j.arthro.2016.03.081

[12] The role of the peroneal tendons in passive stabilisation of the ankle joint: an in vitro study. Knee Surgery, Sports Traumatology, Arthroscopy. 2012. DOI: 10.1007/s00167-012-2273-2

[13] In‐Office Needle Tendoscopy of the Peroneal Tendons. Arthroscopy Techniques. 2022. DOI: 10.1016/j.eats.2021.11.002

[14] Reattachment of the superior peroneal retinaculum versus the bone block procedure for the treatment of recurrent peroneal tendon dislocation: two safe and effective techniques. Knee Surgery, Sports Traumatology, Arthroscopy. 2019. DOI: 10.1007/s00167-019-05479-2

[15] Incidence of reoperation and wound dehiscence in patients treated for peroneal tendon dislocations: comparison between osteotomy versus soft tissue procedures. Knee Surgery, Sports Traumatology, Arthroscopy. 2016. DOI: 10.1007/s00167-016-4383-8

[16] Isolated inferior peroneal retinculum tear in professional soccer players. Injury. 2013. DOI: 10.1016/s0020-1383(13)70202-x

[17] Endoscopic fibular groove deepening for stabilisation of recurrent peroneal tendons instability in a patient with open physes. Knee Surgery, Sports Traumatology, Arthroscopy. 2016. DOI: 10.1007/s00167-016-4210-2

[18] Endoscopic management of recalcitrant retrofibular pain without peroneal tendon subluxation or dislocation. Archives of Orthopaedic and Trauma Surgery. 2011. DOI: 10.1007/s00402-011-1392-4

[19] Peroneal tendinosis as a predisposing factor for the acute lateral ankle sprain in runners. Knee Surgery, Sports Traumatology, Arthroscopy. 2015. DOI: 10.1007/s00167-015-3562-3

[24] Congenital abnormalities of the peroneal tendons have been described, but the descriptions have been based primarily on anatomical dissections2'3. There have been few clinical reports on developmental anomalies that caused symptoms"4'5. The following case is an example of that phenomenon.. 1991.

[25] Salvage Reconstruction for Lateral Ankle Instability Using a Tendon Allograft. Clinical Orthopaedics and Related Research. 2003. DOI: 10.1097/01.blo.0000092976.12414.b0

[27] Aaos Comprehensive Orthopaedic Review 3. Tendon Disorders of the Foot and Ankle > III. Disorders of the Peroneal Tendons.

[32] Successful reconstruction of distal peroneus longus tendon dislocation associated with a split lesion – a case report. BMC Musculoskeletal Disorders. 2020. DOI: 10.1186/s12891-020-03757-6

[33] Ligamentous Injuries and the Risk of Associated Tissue Damage in Acute Ankle Sprains in Athletes. The American Journal of Sports Medicine. 2014. DOI: 10.1177/0363546514529643

[35] Clinical Outcomes and Sports Participation After the Modified Broström Procedure in Children and Adolescents With Chronic Lateral Ankle Instability: A 5- to 10-Year Follow-up of 111 Cases. The American Journal of Sports Medicine. 2025. DOI: 10.1177/03635465251354961

[40] Miller S Review Of Orthopaedics. PERONEAL TENDONS.

[41] Miller S Review Of Orthopaedics. SECTION 16 PATELLAR TRACKING IN TOTAL KNEE ARTHROPLASTY > PERONEAL TENDONS.

[42] Campbell S Operative Orthopaedics 4 Volume Set. SUTURE ANCHOR REPAIR OF PATELLAR TENDON RUPTURE > REPAIR OF THE SUPERIOR PERONEAL RETINACULUM > FIBULAR GROOVE DEEPENING WITH TISSUE TRANSFER (PERIOSTEAL FLAP) FOR RECURRENT PERONEAL TENDON DISLOCATION.

[46] Tendoscopic peroneal retinaculum repair for recurrent peroneal tendon dislocation enables earlier return to sports than the open procedure. Knee Surgery, Sports Traumatology, Arthroscopy. 2020. DOI: 10.1007/s00167-020-05877-x

[51] Orthopaedic Knowledge Update. Ankle Injuries* > Peroneal Tendon Injuries.

[54] Campbell S Operative Orthopaedics 4 Volume Set. MULTIPLE Z-PLASTY RELEASE OF A CONGENITAL RING > DISTAL PERONEAL LONGUS TENDINITIS ASSOCIATED WITH OS PERONEUM: THE PAINFUL OS PERONEUM SYNDROME.

[71] High return to sports and return to work rates after anatomic lateral ankle ligament reconstruction with tendon autograft for isolated chronic lateral ankle instability. Knee Surgery, Sports Traumatology, Arthroscopy. 2022. DOI: 10.1007/s00167-022-06937-0

Creative Commons BY-NC 4.0

CC Creative Commons licence
BY Attribution — you must credit the source
NC NonCommercial — not for commercial use

Attribution-NonCommercial 4.0 International

Creative Commons Corporation ("Creative Commons") is not a law firm and does not provide legal services or legal advice. Distribution of Creative Commons public licenses does not create a lawyer-client or other relationship. Creative Commons makes its licenses and related information available on an "as-is" basis. Creative Commons gives no warranties regarding its licenses, any material licensed under their terms and conditions, or any related information. Creative Commons disclaims all liability for damages resulting from their use to the fullest extent possible.

Using Creative Commons Public Licenses

Creative Commons public licenses provide a standard set of terms and conditions that creators and other rights holders may use to share original works of authorship and other material subject to copyright and certain other rights specified in the public license below. The following considerations are for informational purposes only, are not exhaustive, and do not form part of our licenses.

Considerations for licensors: Our public licenses are intended for use by those authorized to give the public permission to use material in ways otherwise restricted by copyright and certain other rights. Our licenses are irrevocable. Licensors should read and understand the terms and conditions of the license they choose before applying it. Licensors should also secure all rights necessary before applying our licenses so that the public can reuse the material as expected. Licensors should clearly mark any material not subject to the license. This includes other CC- licensed material, or material used under an exception or limitation to copyright. More considerations for licensors: wiki.creativecommons.org/Considerations_for_licensors

Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.