This 2009 JAAOS narrative review by Philbin et al. covers the full spectrum of peroneal tendon pathology — tenosynovitis, peroneus brevis and longus tears, painful os peroneum syndrome, concomitant tears, and subluxation/dislocation — addressing anatomy, imaging criteria, classification systems, and surgical decision-making for a commonly underdiagnosed cause of chronic lateral ankle pain.
When a patient has chronic lateral ankle pain that hasn't resolved after an ankle sprain workup, actively interrogate the peroneal tendons: look for swelling posterior to the fibula, pain with resisted eversion, and a fleck avulsion on plain film (SPR injury).
Don't default to conservative management for peroneus brevis tears with concurrent instability — the 83% nonsurgical failure rate means early surgical referral is appropriate for active patients.
This 2009 JAAOS narrative review by Philbin et al. covers the full spectrum of peroneal tendon pathology — tenosynovitis, peroneus brevis and longus tears, painful os peroneum syndrome, concomitant tears, and subluxation/dislocation — addressing anatomy, imaging criteria, classification systems, and surgical decision-making for a commonly underdiagnosed cause of chronic lateral ankle pain.
When a patient has chronic lateral ankle pain that hasn't resolved after an ankle sprain workup, actively interrogate the peroneal tendons: look for swelling posterior to the fibula, pain with resisted eversion, and a fleck avulsion on plain film (SPR injury).
Don't default to conservative management for peroneus brevis tears with concurrent instability — the 83% nonsurgical failure rate means early surgical referral is appropriate for active patients.