Peroneal Tendon Syndromes

Peroneal tendon disorders are a cause of hindfoot and lateral foot pain. There are three primary disorders of the tendons; peroneal tendonitis, peroneal subluxation, and peroneal tendon tears; these conditions are a cause of lateral ankle pain and may lead to ankle instability. The peroneal tendons are in the lateral compartment of the leg and include the peroneus longus and peroneus brevis muscles. Both receive innervation from the superficial peroneal nerve and blood supply from the peroneal artery. The peroneus brevis originates on the lateral aspect of the distal fibula and intermuscular septum and inserts onto the base of the fifth metatarsal. The peroneus longus originates at the proximal fibula and lateral tibia and inserts at the base of the first metatarsal and the medial cuneiform. The tendons occupy a common synovial sheath that runs posterior to the distal fibula, once past the fibula they each have their own synovial sheath. They run in a tunnel bordered by the superior peroneal retinaculum, the posterior fibula that has a retromalleolar groove, and the calcaneofibular ligament. Tendon relationship at the level of the ankle is the peroneus brevis anterior and medial to the peroneus longus. Sometimes anomalous anatomy can lead to a peroneal disorder such as low lying brevis muscle belly or the presence of peroneus quartus muscle. The peroneus quartus muscle most commonly runs form the peroneus brevis to the retrotrochlear eminence of the calcaneus and is associated with peroneus brevis tears, and subluxation.