The decision to undergo peroneal tendon surgery often follows persistent pain and instability in the ankle. Peroneal tendons (peroneus longus and brevis) are strong bands of tissue running along the outside of the ankle. Their primary function is to stabilize the ankle joint and facilitate eversion (outward rotation of the foot), helping to protect against sprains. When these tendons suffer a severe tear, tendinosis, or chronic instability, surgery may be necessary to restore structural integrity and function.
Conservative Treatment Options
Before considering surgery, a structured program of conservative treatment is the standard initial approach for most peroneal tendon issues. Initial management typically involves rest, applying ice, and using non-steroidal anti-inflammatory drugs (NSAIDs) to control pain and swelling. Immobilization is frequently employed using an ankle brace or a walking boot to restrict movement and take stress off the injured tendons, allowing acute symptoms to subside.
Physical therapy is a central component, focusing on specific protocols like eccentric strengthening exercises. Conservative treatment is generally pursued for a minimum of three to six months for chronic conditions. Surgery is reserved for cases that fail to improve after this dedicated period or for acute, severe injuries, such as complete tendon ruptures or chronic instability where the tendon repeatedly dislocates.
Surgical Approaches for Peroneal Tendon Repair
Surgical intervention is tailored precisely to the type and extent of the injury found during the procedure.
Tendon Repair and Grafting
For less severe longitudinal splits or chronic tendinosis, the surgeon often performs tendon debridement, which involves removing the damaged or degenerated tissue. The remaining healthy tendon is then repaired using sutures, a technique sometimes called tubularization. When the injury involves a full-thickness tear or a large, irreparable defect, a more complex approach is required. Tenodesis involves attaching the damaged peroneal tendon to the nearby healthy peroneal tendon. Grafting may use tissue taken from another tendon in the foot, or an allograft, to bridge the gap and restore length.
Stabilization for Chronic Subluxation
In cases of chronic subluxation, where the tendons repeatedly slip out of place behind the ankle bone, the procedure focuses on stabilization. This can involve repairing the superior peroneal retinaculum, the ligament that holds the tendons in their groove. Alternatively, a retromalleolar groove deepening procedure may be performed. This reshapes the groove in the fibula to create a more concave surface, which prevents the tendons from dislocating.
Expected Recovery and Rehabilitation Timeline
Recovery following peroneal tendon surgery is lengthy and phased. Immediately following the operation, the ankle is immobilized in a cast or splint. Patients must remain strictly non-weight bearing for the first four to six weeks to allow proper tendon healing while the repairs are most vulnerable.
The transition to partial weight bearing begins after this immobilization period, often using a walking boot as guided by the surgeon. Around six weeks post-surgery, formal physical therapy typically commences, initially focusing on restoring a pain-free range of motion. Therapy then progresses to gentle strengthening of the surrounding muscles. Subsequent phases involve advanced strengthening, proprioception training to improve balance, and functional training. Patients usually return to low-impact activities and daily walking between three and four months after surgery. A full return to higher-impact sports often requires six months or longer, depending on the injury severity and the specific procedure performed.
Assessing Success Rates and Potential Complications
For patients who have failed conservative treatment, peroneal tendon surgery generally offers a positive prognosis and improved quality of life. Studies consistently report high rates of success, with many patients achieving significant pain relief and a marked improvement in ankle stability. Functional outcome scores, which measure a patient’s ability to perform daily activities, show substantial improvement following surgical intervention. Despite the high success rates, a clear understanding of potential complications is important. The overall complication rate is cited as being around 38.7%, though many of these are minor.
Potential complications include:
- Persistent ankle pain.
- Irritation or damage to the sural nerve, which can lead to numbness along the outside of the foot.
- Recurrence of the original problem, such as re-tearing of the repaired tendon or recurrence of subluxation.
- Rarely, more severe issues like infection or delayed wound healing.