Peroneal tendons are crucial structures on the outer side of the ankle that help with movements like turning the foot outward (eversion). Injuries to these tendons, especially tears or ruptures, are common causes of ankle pain and dysfunction. These injuries often go unnoticed or are mistaken for simpler ligament injuries, which is why it’s important for healthcare providers to thoroughly examine the area and conduct appropriate tests to confirm the diagnosis.
When more than half of the tendon is damaged, non-surgical treatments like rest, physical therapy, and anti-inflammatory medications are typically the first course of action. However, if these methods don’t provide relief, surgery might be needed. One surgical option involves transferring the peroneus longus tendon to replace the damaged peroneus brevis tendon.
Why the Peroneus Brevis to Longus Transfer?
The peroneus longus tendon, when transferred to the brevis tendon, serves as a substitute for the damaged tendon. This transfer can help restore normal ankle function, allowing for movements like eversion (turning the foot outward) and inversion (turning the foot inward). This procedure is particularly useful for patients with severe tendon damage.
How the Procedure Works
The surgery involves making an incision on the outer side of the ankle to access the tendons. The damaged peroneus brevis tendon is removed, and the peroneus longus tendon is carefully moved and reattached at the foot. The procedure ensures that the new tendon insertion restores normal ankle motion without compromising strength. The peroneus longus tendon’s role in helping the foot turn outward (eversion) is key in this transfer.
This transfer is usually performed when more than 50% of the peroneus brevis tendon is damaged, and it offers a more robust and durable solution than other methods like tendon suturing or simple debridement.
Benefits of Peroneus Longus to Brevis Transfer
Restoration of Strength and Function: The study found that patients who underwent the tendon transfer had similar strength and range of motion in their ankles compared to the healthy ankle. This means that the transfer does not limit the ability to turn the foot outward or inward.
Improved Clinical Scores: After surgery, patients showed improvement in clinical outcomes, as evidenced by their scores on various functional and pain scales (e.g., AOFAS hindfoot score, German Foot Function Index). These scores measure how well the ankle is functioning and the level of pain, with higher scores indicating better outcomes.
Post-Operative Care
After surgery, the ankle is kept immobilized for a few weeks to allow for healing. Patients typically use crutches to keep weight off the ankle for up to six weeks. Following this period, a stepwise approach to rehabilitation, including physical therapy, helps patients regain full function and strength.
Conclusion
The peroneus longus to brevis tendon transfer is a reliable and effective surgical option for patients with severe damage to the peroneus brevis tendon. The procedure helps restore normal ankle function without compromising strength or range of motion. Patients can expect significant improvements in clinical and functional outcomes, with a relatively straightforward recovery process.
Do you have more questions?
Q. What are peroneal tendon injuries?
A. Peroneal tendon injuries involve damage to the peroneal tendons on the outer side of the ankle, often resulting in pain, swelling, and difficulty with foot movement, especially with eversion (turning the foot outward).
Q. How is a peroneal tendon injury diagnosed?
A. Diagnosis typically involves a physical examination, medical history, and imaging tests such as MRI or ultrasound to assess the extent of tendon damage and confirm the diagnosis.
Q. What is the peroneus longus to brevis tendon transfer procedure?
A. This surgical procedure involves transferring the healthy peroneus longus tendon to replace the damaged peroneus brevis tendon to restore function and strength to the foot and ankle, particularly improving eversion.
Q. When is peroneus longus to brevis tendon transfer surgery necessary?
A. Surgery is usually necessary when more than 50% of the peroneus brevis tendon is damaged and conservative treatments like rest, physical therapy, or bracing do not provide sufficient relief.
Q. What are the benefits of the peroneus longus to brevis tendon transfer?
A. Benefits include restored strength, normal ankle function, improved range of motion, and enhanced clinical outcomes, such as pain relief and better functional scores.
Q. What is the recovery time after peroneus longus to brevis tendon transfer?
A. Recovery includes immobilization for a few weeks, followed by crutches for 4 to 6 weeks. Full recovery may take several months, with physical therapy helping to restore function and strength.
Q. What are the risks of peroneus longus to brevis tendon transfer surgery?
A. Risks include infection, nerve injury, tendon failure, and complications related to the surgical site, though these are relatively rare and can be managed with proper care.
Q. How effective is the peroneus longus to brevis tendon transfer procedure?
A. The procedure is highly effective, with patients experiencing restored ankle function, improved strength, and a reduction in pain, with many returning to normal activities after recovery.
Q. Can peroneal tendon injuries be treated without surgery?
A. Yes, mild to moderate peroneal tendon injuries can often be treated conservatively with rest, ice, anti-inflammatory medications, physical therapy, and the use of supportive footwear or ankle braces. Surgery is typically reserved for more severe cases.
Q. What are the symptoms of a peroneal tendon injury?
A. Symptoms include pain on the outer side of the ankle, swelling, bruising, weakness in the ankle, instability, and difficulty with activities involving foot movement, especially when turning the foot outward.
Q. How is peroneal tendon damage prevented?
A. Preventative measures include strengthening the ankle and foot muscles, using proper footwear, avoiding excessive strain on the tendons, and practicing balance exercises to improve stability and reduce the risk of injury.
Q. Will I be able to return to sports after a peroneal tendon injury?
A. Most patients can return to sports after recovery, although the timeline depends on the severity of the injury and how well the tendon heals. Full recovery may take several months, and high-impact activities should be avoided until healing is complete.
Q. What are the long-term effects of untreated peroneal tendon injuries?
A. If left untreated, peroneal tendon injuries can lead to chronic pain, ankle instability, increased risk of recurrent injuries, and, in severe cases, tendon rupture or permanent loss of function in the ankle.
Q. Can peroneal tendon injuries occur in both tendons at the same time?
A. Yes, it is possible for both the peroneus longus and peroneus brevis tendons to be injured simultaneously, which can result in more significant ankle instability and functional limitations.
Q. Is peroneal tendon surgery effective for everyone?
A. While peroneal tendon surgery is effective for most patients, its success depends on factors such as the extent of the tendon damage, the patient’s overall health, and adherence to post-surgical rehabilitation.
Q. Can peroneal tendon injuries lead to other foot or ankle conditions?
A. Yes, untreated or chronic peroneal tendon injuries can lead to other issues such as flatfoot, lateral ankle instability, and the development of secondary conditions like tendonitis or arthritis due to compensatory mechanics.
