#759 Does a split peroneal tendon always require surgery in runners? - DOC

#759 Does a split peroneal tendon always require surgery in runners?

Does a split peroneal tendon always mean you have to have surgery if you’re a runner? Well, that’s what we’re talking about today on the Doc On The Run Podcast.



If you get pain on the outside of your ankle, in this area, around this bone that we call the fibula, which that’s the lump you feel if you look down in your ankle and you push around you feel a lump, that’s the end of the fibula.

You have two tendons that sit behind there. You have the peroneus longus that starts up high then comes down and attaches all the way around here on the bottom of your foot and you have the peroneus brevis which is shorter, which is why it’s called the brevis and it sits down here, the tendon comes around and it attaches to that bump on the outside of your foot.

The peroneal tendons help stabilize you. They’re kind of your landing gear when you run. They keep you from wobbling, swaying and when you start to roll your ankle, they pull your foot back under you. But if you get irritation and aggravation of the tendon that you ignore, you could split it. If you suddenly roll your ankle or you have trauma of some kind, you might actually get a split.

A split means it’s up and down the length of the tendon just like if you cut a slit in this bone, that would be the equivalent of a split that we’re talking about here. And of course, a lot of times doctors, if you look this up, if you look for a split peroneal tendon, one of the first things you may find is that the doctors say this is a surgical problem. You have to have surgery, you always have to have surgery to repair a split peroneus brevis tendon. That’s not always true and I wanted to try to explain why.

The first thing is that the tendons are actually running together when they curve around your ankle. They’re in a common tendon sheath. They’re basically going together. And when they’re together in there, they’re very secure in house but behind your fibula, you have the brevis is in the front and the longus is in the back. If you split the brevis, what happens is the longus tries to force its way forward and it actually pushes those two pieces apart and then they can’t get back together.

So, when you have a split in peroneus brevis tendon behind the fibula right before where it curves around, they’re not going to get together again, without surgery. So, that actually is a surgical problem. If you have pain because you have a split apparently is brevis tendon, if you don’t think that it will probably get worse because the peroneus longus keeps pushing its way in there between those two pieces, and it keeps forcing it apart over and over and actually rips a little bit more out that way and a little more down that way and then they’re not going to get together again unless you fix it.

The peroneus longus is sitting behind there. So, the peroneus longus first of all, if it’s split, you don’t have pain. I don’t know why you’d want to have surgery. If you have a split in the longus that’s down in this area, on this side of the foot, well, I’ve seen lots of runners that have those splits that aren’t really painful that actually call them down. And because they’re not getting pushed on anymore, they’re just being pulled like a cable or a rope, it may not be painful.

If you have a split that’s non-painful, and it actually calms down over time, even if it doesn’t actually fully repair itself and turn back into one solid tendon and that split doesn’t completely go away, it may become non-painful and not be one of those things that warrants going to the operating room and having surgery.

Sometimes on the bottom of the foot you can have a split and I’ve seen those that actually calm down without surgery and the bottom of the foot where you have that peroneus longus tendon is not really a place most surgeons want to go anyway, there’s lots of stuff in there, that can get messed up. It’s a very risky area to operate on your foot. And if you just try and operate it can cause more problems than good.

So, you’ve got to understand there’s differences in the location of the injury to the peroneal tendons that helps you decide whether or not you really need surgery and certainly, if your surgeon is going to recommend surgery, they’ll explain all these things to you. But if you understand a little bit about it before you go in to see them, hopefully that’ll help you make a better decision on whether or not you really need surgery to get back to running when you have a split in one of the peroneal tendons.

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