The peroneal tendons (peroneus longus and peroneus brevis) are two strong bands of tissue running along the outside of the ankle, connecting lower leg muscles to foot bones. Their primary function is to stabilize the ankle during side-to-side movements and walking on uneven ground. A tear causes pain and instability along the outer ankle. Whether a peroneal tendon tear can heal without surgery depends on its specific characteristics and severity.
Understanding Peroneal Tendon Tears
Peroneal tendon injuries are categorized by timing and extent of damage. Acute tears result from a sudden, traumatic event, like an ankle roll, where the injury moment is pinpointed. Chronic tears develop slowly due to repetitive stress, overuse, or degenerative changes, and are often more common.
The severity is defined by whether the tear is partial or complete. A partial tear (Grade 2) means some fibers are damaged, but the tendon remains intact and provides stability. A complete tear, or rupture (Grade 3), means the tendon is fully severed into two pieces. Chronic tears frequently manifest as longitudinal split tears running along the length of the tendon fibers.
Criteria for Conservative Healing
Non-surgical healing is primarily viable for acute, low-grade partial tears where the ankle joint remains stable. Success is highest when the tear involves less than 50% of the tendon’s thickness. Underlying ankle stability is a major factor, as the peroneal tendons prevent the ankle from “giving out.”
For a non-operative approach to succeed, the tear must not be associated with significant injury to the superior peroneal retinaculum. Minimal retraction of the torn tendon fibers is also a favorable sign. Patient compliance is important, requiring strict adherence to immobilization and rehabilitation protocols. The goal is to allow the tendon to repair itself biologically while protecting it from worsening forces.
Non-Operative Treatment Protocols
Conservative management begins with protection, rest, and reducing inflammation. The RICE method (Rest, Ice, Compression, and Elevation) is commonly used to manage initial pain and swelling, often supplemented by Nonsteroidal anti-inflammatory drugs (NSAIDs).
The initial protection phase involves immobilization to eliminate stress on the healing tendon. This is typically achieved with a brace, walking boot, or cast, depending on symptom severity. Immobilization usually lasts four to six weeks, often restricting weight-bearing. The rehabilitation phase begins once pain and swelling subside, focusing on restoring function and strength.
Physical therapy is necessary, starting with gentle range-of-motion exercises. This progresses to strengthening exercises for the foot and ankle, often using resistance bands. Proprioception training, which improves balance and joint position awareness, is then introduced to prepare the ankle for a return to full activity. Full recovery can take several months.
Recognizing When Surgery Becomes Necessary
Surgery is required for all complete tears (Grade 3 ruptures). It is also necessary for significant instability, such as a concurrent tear of the superior peroneal retinaculum causing the tendons to slip out of their groove. Chronic longitudinal split tears involving over 50% of the tendon often require surgical intervention to debride and repair the damaged tissue.
Even if initially suitable for conservative care, surgery becomes necessary if non-operative treatment fails. Failure is defined by the persistence of symptoms, including pain, swelling, or ankle instability, after three to six months of dedicated conservative management. Furthermore, tears associated with other bone or ligament damage, such as a fracture or severe ankle sprain, often need an operative approach to address all coexisting injuries.