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Hi all!

Does anyone have experience with peroneus longus tears? I have a colleague who is a distance runner who recently tore hers with an inversion injury to her ankle (confirmed by MRI). At her baseline she has a weak posterior tib with a history of post. tib. tendonitis and plantar fasciitis (neither are active now). Despite these baseline problems, she has qualified for the Olympic Marathon trials four different times! Her pain is from midstance to pushoff in the area of her lateral and plantar calcaneus. Any thoughts on long term consequences and implications for orthotic management? I do not currently know the size of the tear.

Thanks,
Ann

Peroneus longus tendon tears in a distance runner can successfully be treated conservatively in some cases if the tear (generally a longitudinal split of the tendon) is relatively mild.

If the tear is new, then try putting her in a cam walker style brace for 4 weeks, with no running. This may allow it to heal if the tear is minor. Icing, using a 2-5 forefoot valgus extension on an orthosis along with some increased valgus wedging on the orthosis may help the pain, but also may, unfortunately, exacerbate her posterior tibial tendinitis.

Most of these tears do well with surgical repair but this would mean at least 3 months or more of no running. If it were my foot, and the tear did not respond to immobilization, and orthosis modifications, then I would have the surgery done.

Hope this helps.

__________________
Sincerely,

Kevin

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Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

e-mail: kevinakirby@comcast.net

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107 Scripps Drive, Suite 200
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The PL tear is obviously the main consideration here. The inversion trauma has obviously increased tensile stress beyond the physiological limit.

Our job is to remove the workload and tensile stressors from the structure.

1. If ankle strapping/bracing does not alleviate signs/symptoms, then Kevin's idea regarding the cam sounds good.

2. Valgus wedging

3. Short-term, may be good for the tear to stop wearing orthoses until the primary pathology mends.

4. Strapping for return-to-sport.

5. Long-term, a cuboid notch to assist/unload the PL. Review rear-foot posting aggression. Forefoot valgus wedging sounds good in theory, but that would not come into play until FF loading. Your mandatory inversion injury would occur closer to HS IMO. Therefore, we want the forces applicable there.

Related threads:
Peroneal Subluxation
Pes Cavus w/ Peroneal spasms
Peroneal Tendon Dysfunction
Help with patient with lateral leg pain

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