Can my doctor tell me if I need surgery on my peroneal tendon just by looking at my ankle? Well, that’s a great question and that’s what we’re talking about today on the Doc On The Run Podcast.
Today’s episode actually comes from one of the YouTube viewers who was watching a video called Can I run with a split peroneal tendon, and I was trying to explain the circumstances about when you can run with it and when it really is something you shouldn’t try.
What he said in his comment was he wanted to know if his doctor could tell him whether or not he needed surgery just by looking at his ankle. And he said in his comment that the MRI tells me I have a split tear. So, presumably as a tear in the peroneal tendon, but I don’t know which one. I don’t know if it’s the peroneus brevis and I don’t know if it’s peroneus longus. But they run together around the side of the ankle down the side of the foot, and He further says that he was in a cast for an Achilles tendon injury, but not sure if my other tears can be fixed.
There are a couple of interesting things about this that make for I think, a useful episode here and one is that it sounds like he was actually being treated for an Achilles tendon injury and that maybe through the process of assessing the status of that injury, sort of discovered that there was a peroneal tendon injury.
I don’t know if he was having pain in the peroneal tendons before or not. But he said he got an MRI and his doctor was saying that maybe he needed to have surgery, but couldn’t really tell if the doctor could tell just by looking at his ankle, I don’t know. So, I’m not sure on the real specifics of his actual circumstance, but there’s something that I think you really have to understand if you have peroneal tendon injuries, particularly if you don’t really have pain there and your doctor is recommending that you have surgery.
This is a research study that was published in the clinics in orthopedic surgery back in 2010 and in that study, the researchers actually found that when they looked at 82 cases of ankle pain with suspected peroneal tendon tears around the ankle, what they found was 26 out of those 82 were actually true positives. This is where they definitely had a split and that split was showing up on the MRI.
They also had 38 true negatives, meaning that there was no split on the MRI and they did not have a tear in the peroneal tendon even if they had pain. The other thing that’s really important is there were 13 false positives, 13 out of 82. Now that’s quite a bit, right. So ,13 of these cases, the patients did not have a split in the peroneal tendon, but the MRI showed there was a split and the peroneal tendon.
How could that be? Well, the way that the peroneal tendons curve around the ankle, it can cause this abrasion on MRIs where it actually looks like there’s a split in the tendon when there actually isn’t. That’s really important. So, you could have other things if you do have pain in that area that’s not a split that needs to be treated surgically. Even if it was a split, not all of them need to be treated surgically.
It could be tenosynovitis where you have inflammation in the sheath around those two tendons. You could have tendon dislocation where the tendons are kind of flipping back and forth or across the front of the fibula bone on the outside of the ankle. You could have a low line muscle belly where the peroneus brevis muscle belly itself is actually extending down into the tendon sheath and crowding that tunnel. Or you could even have a little accessory muscle called peroneus quartus that actually protrudes all the way down, crowds that area and causes a lot of sort of tension stress and annoyance of the tendons in the peroneal tendon sheath.
In any event, what I would do is look at it with ultrasound. So, if I was thinking you needed surgery, and I was doing a second opinion for you, and your MRI said maybe you have a split in the peroneal tendon but you weren’t having pain around the peroneal tendons. The first thing I would do is look at it with ultrasound and see if I could see a tendon split on ultrasound and if I couldn’t find one, I’d say you wouldn’t need surgery. But again, I don’t know the specifics of this case but a couple of things to think about if you have a split peroneal tendon or you’re having a peroneal tendon pain, and you’re trying to get back to running.
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Park HJ, Cha SD, Kim HS, Chung ST, Park NH, Yoo JH, Park JH, Kim JH, Lee TW, Lee CH, Oh SM. Reliability of MRI findings of peroneal tendinopathy in patients with lateral chronic ankle instability. Clin Orthop Surg. 2010 Dec;2(4):237-43.