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Peroneus tertius 'snapping'

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  #1  
Old 6th October 2009, 04:24 AM
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Default Peroneus tertius 'snapping'

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I saw a female runner yesterday with history of chronic lateral ankle instability. O/E pain was elicited by the peroneus tertius tendon snapping over the talar head with STJ supination.

Does anyone have a copy of this paper they can e-mail me?
G. James Sammarco and Carlo Henning
Peroneus Tertius Muscle as a Cause of Snapping and Ankle Pain
Am J Sports Med August 2007 35:1377-1379; PreView February 9, 2007.
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Old 6th October 2009, 06:44 AM
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Default Re: peroneus tertius snapping

Thanks to Kevin for supplying a copy of the paper. Has anyone any pearls for conservative treatment of this condition?
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Old 6th October 2009, 02:49 PM
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Default Re: peroneus tertius snapping

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Originally Posted by Simon Spooner View Post
Thanks to Kevin for supplying a copy of the paper. Has anyone any pearls for conservative treatment of this condition?
Simon:

As the authors stated "a very rare condition that has not been previously reported".....I've never seen the beast.
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Old 6th October 2009, 04:40 PM
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Default Re: Peroneus tertius 'snapping'

heya,

it's not the conservative tx u were looking for, but i found this procedure by accident, thought u might wanna know

Intrasheath Subluxation of the Peroneal Tendons
Surgical Technique
Steven M. Raikin, MD
The Journal of Bone and Joint Surgery (American). 2009;91:146-155.

there is a matching video;
Peroneal Groove Deepening for Subluxation of the Peroneal Tendons; plus Brostrøm-Gould Ankle Ligament Repair
Steven M. Raikin and Levon N. Nazarian
Video J Orthopaed, Mar 2009; Video # 1030
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Old 6th October 2009, 11:42 PM
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Default Re: Peroneus tertius 'snapping'

I was thinking about this while finishing some devices this morning

Heres what I can up with, which I guess most of you will have thought of but here goes

1 control stj pronation to reduce the tension of the peroneus tertius.

2 Fit a small varus wedge under the styloid process of the 5th to slightly dorsiflex and evert the base of the 5th to further reduce tension on the peroneus tertius

3 the extensor retinaculum also needs some help holding down the peroneus tertius, so try taping from medial to lateral over the extensor retinaculum or you could try a swiss ankle brace with laces on the from to put pressure over the retinaculum, but the best idea I thought was you could try one of those velcro bands that people try with patella tendonitis which might help reduce irratation on the achilles tendon and can be adjusted by the patient.

Just some thoughts .
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Old 7th October 2009, 12:35 AM
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Default Re: Peroneus tertius 'snapping'

Quote:
Originally Posted by m weber View Post

1 control stj pronation to reduce the tension of the peroneus tertius.
You mean supination.
Quote:
Originally Posted by m weber View Post

3 the extensor retinaculum also needs some help holding down the peroneus tertius, so try taping from medial to lateral over the extensor retinaculum or you could try a swiss ankle brace with laces on the from to put pressure over the retinaculum, but the best idea I thought was you could try one of those velcro bands that people try with patella tendonitis which might help reduce irratation on the achilles tendon and can be adjusted by the patient.
I agree, we will be trying taping after an initial rest period. I think the laced ankle brace might be a little to heavy duty and have been leaning toward a velcro strap version.
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Old 7th October 2009, 12:50 AM
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Default Re: Peroneus tertius 'snapping'

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Originally Posted by Simon Spooner View Post
You mean supination.

Yep sorry Up way to early this morning Supination was want I should have said.

What do you think about the small wedge good idea or not ?
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Old 7th October 2009, 01:06 AM
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Default Re: Peroneus tertius 'snapping'

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Originally Posted by m weber View Post
Yep sorry Up way to early this morning Supination was want I should have said.

What do you think about the small wedge good idea or not ?
I'm going to apply valgus forefoot wedging.
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Old 7th October 2009, 01:13 AM
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Default Re: Peroneus tertius 'snapping'

Be intersted to know how the patient responds over the next few months.
Good luck
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Old 7th October 2009, 01:38 AM
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Default Re: Peroneus tertius 'snapping'

Hi Simon

Interesting case

I have only seen a couple of these in my time.
My first question would be, How is the inferior tib fib translation?
Second is peroneus terious in muscluar dysfunction/Spasm
My success with this have been based around sup tib-fib and infer tib-fib translation movement second work the affected muscle.

Finally if these dont work needle the tendon or try spray and stretch.
If you get these right can be instant resolution.

Regards

Dave
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Old 7th October 2009, 04:02 AM
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Default Re: Peroneus tertius 'snapping'

Quote:
Originally Posted by m weber View Post
1 control stj pronation to reduce the tension of the peroneus tertius.

2 Fit a small varus wedge under the styloid process of the 5th to slightly dorsiflex and evert the base of the 5th to further reduce tension on the peroneus tertius
.
Not having a good day as Siomon pointed out pronation should be supination and I realised varus should be valgus but the discription is correct. The Wedge I was thinking about whould be about 2cm*2cm and try and focus just on the base of the 5th met.

Sorry for confusion but could not edit post as time had run out.

teach me for not proof reading.
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Old 7th October 2009, 04:18 AM
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Default Re: Peroneus tertius 'snapping'

Quote:
Originally Posted by m weber View Post
Not having a good day as Siomon pointed out pronation should be supination and I realised varus should be valgus but the discription is correct. The Wedge I was thinking about whould be about 2cm*2cm and try and focus just on the base of the 5th met.

Sorry for confusion but could not edit post as time had run out.

teach me for not proof reading.
Quite. I'd force-quit and re-boot myself if I were you.

Best wishes,
Siomon
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