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Peroneal tendon disorders

33 citationsUpdated Oct 2026
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Overview

Symptomatic peroneal tendon injuries arise from both acute and chronic processes [1]. Peroneal tenosynovitis is rarely reported and frequently misdiagnosed, often following inversion injury of the ankle [6]. Peroneal tendinosis and peroneal subluxation are uncommon but lifestyle-limiting conditions that worsen if not properly diagnosed and treated [2]. A deficiency in viscoelastic properties of the peroneus longus tendon must be considered in the diagnostic and treatment of ankle instability [12]. All patients with peroneal tendon tears had associated intra-articular pathology, with the majority having more than one lesion [10]. Description of distal peroneal tendon dislocations is limited in the literature [16]. The current understanding of the anatomy and diagnostic evaluation of the peroneal tendons includes both conservative and operative management options for peroneal tendon lesions [7]. The ESSKA-AFAS consensus statement on the optimal management of peroneal tendon pathologies is the result of international and multidisciplinary agreement combined with a systematic review of the literature [5].

Peroneal tendoscopy is a safe and effective minimally invasive technique for managing peroneal tendon disorders, associated with significant short-term improvement in clinical outcomes and low complication and failure rates [9]. It provides good outcomes in the treatment of peroneal tendon pathologies [11], and good clinical outcomes were found in patients with peroneal tendon disorders treated with peroneal tendoscopy [8]. Tendoscopy of the peroneal tendons is an effective and minimal invasive management tool that can be indicated in many of peroneal disorders [4]. However, there is poor evidence (grade Cf) in support of peroneal tendoscopy for the common indications [3]. Further studies are needed and planned to evaluate clinical outcomes after in-office needle tendoscopy (IONT) of the peroneal tendons [13].

For recurrent peroneal tendon dislocation, both reattachment of the superior peroneal retinaculum and the bone block procedure offered satisfactory results with low rates of recurrence and complications [14]. Soft tissue procedures offer a satisfactory method of treating peroneal tendon dislocations without any additional risk of reoperation when compared to osteotomy techniques that have potentially greater complication rates [15]. Endoscopic stabilisation of peroneal tendons in a child with open physes gives good functional outcomes without growth plate disturbance [17]. The advantages of the minimally invasive approach for endoscopic retrofibular groove deepening and resection of a low-lying muscle of the peroneus brevis include better cosmetic results, minimal soft tissue trauma, decreased postoperative pain, early mobilization and faster postoperative recovery, less peritendinous fibrosis, and less subjective tightness at the peroneal tendons [45].

Anatomy & Pathophysiology

Anatomy

The peroneus longus and peroneus brevis muscles originate from the fibula and interosseous membrane [25]. The peroneus brevis originates specifically from the distal half of the lateral fibula, while the peroneus longus originates more proximally on the lateral fibula [53]. Both tendons are innervated by the superficial peroneal nerve (S1) [25]. They run posterior to the lateral malleolus within the retromalleolar sulcus, also known as the peroneal groove, which is formed posteriorly in the fibula [25, 53]. Within this groove, the peroneus brevis tendon is positioned anterior and medial to the peroneus longus tendon [25]. The groove is deepened by a fibrocartilaginous rim that provides moderate inherent stability to the tendons [53]. The superior peroneal retinaculum (SPR) runs from the posterolateral ridge of the fibula to the lateral calcaneus and functions as the primary restraint to peroneal tendon subluxation within the retromalleolar sulcus [53].

Both peroneal tendons curve anteriorly around the tip of the fibula [25]. At the level of the calcaneus, the peroneal tubercle separates the peroneus longus and peroneus brevis tendons [25]. The peroneus brevis tendon runs distally to insert onto the tuberosity of the base of the fifth metatarsal [25, 53]. The peroneus longus tendon makes a 90° turn medially at the cuboid groove before inserting into the base of the first metatarsal and medial cuneiform [25, 53]. The primary function of the peroneal tendons, particularly the peroneus brevis, is to evert the hindfoot, with secondary plantarflexion of the ankle [25]. The peroneus longus additionally plantarflexes (pronates) the first ray [25]. These tendons also provide supplemental lateral ankle stability [53].

Anatomic variations and structural features influence tendon health. A vascular watershed region just posterior to the fibula is the most common area of injury for the peroneal tendons [25]. The peroneus brevis muscle belly typically terminates approximately 3 cm from the tip of the fibula [53]. A low-lying peroneus brevis muscle belly is an anatomic variation implicated in tendon tears and instability [25]. The presence of a peroneus quartus muscle, found in 13% to 22% of individuals, is another variation implicated in tendon tears and instability; it may be seen in the fibular groove and contributes to crowding of the fibro-osseous tunnel [25]. Anatomical variations of the peroneus brevis tendon have been classified into three main types based on attachment to the calcaneus, cuboid, or peroneus longus tendon [22]. The peroneocalcaneal variant is the most common and has been classified into six subtypes [22]. The most common anomaly of the peroneus brevis is an additional tendinous slip without anomalous muscle tissue that passes through the peroneus tertius and inserts on the long extensor of the fifth toe or the shaft of the fifth metatarsal [22]. LeDouble found a well-developed peroneus brevis slip in 22% of cadavera and a vestigial one in an additional 13% [22].

Pathophysiology

Peroneal tendon injuries often result from mechanical trauma within the retromalleolar sulcus. Longitudinal split tears of the peroneus brevis are usually found within this sulcus, indicating they are likely due to mechanical trauma in this region [18]. Cadaveric studies suggest that the splitting of the peroneal tendon develops through a mechanical mechanism with the central portion of the longitudinal split centered over the distal tip of the fibula in the fibular groove [18]. Peroneal tendon tears can occur in the 25–15° range of plantar flexion as the peroneus longus impinges against the tip of the fibula and as the peroneus brevis impinges against the lateral wall of the peroneal groove [18]. Anatomical studies have demonstrated that the peroneal tendons are perched along the distal fibula at 15° to 25° of plantar flexion, making them susceptible to inversion injury at this position [53]. Peroneal tendon injury occurs when there is rapid dorsiflexion of the inverted foot, causing reflexive contraction of the peroneus brevis and longus, which can lead to frank tendon injury or injury to the superior peroneal retinaculum (SPR) [53].

Dislocation or subluxation occurs during an inversion injury to a dorsiflexed ankle with rapid reflexive contraction of the peroneus longus and peroneus brevis tendons [25]. This mechanism results in a disruption of the superior peroneal retinaculum (SPR) or fibrocartilage ridge [25]. Patients with dislocation or subluxation describe a “pop” or snapping sensation, followed by pain and swelling [25]. In cases in which the SPR is disrupted, the peroneal tendons will subluxate repeatedly, which often leads to longitudinal tears, most frequently in the peroneus brevis where it runs within the fibular groove [53]. Chronic symptoms can develop when the tendons are not anatomically located in their retromalleolar position and subsequently subluxate abnormally with ankle motion [53]. Acute longitudinal tendon tears may also occur during the setting of dislocation or subluxation [25].

Contributing factors to peroneal tendon tears include overcrowding of the peroneal groove, instability of the superior peroneal retinaculum, lateral ankle instability, contraction of the peroneus longus, hypovascularity of the peroneus brevis tendon, and a shallow peroneal groove of the fibula [18]. A shallow peroneal groove and overcrowding of the fibular groove are predisposing factors for dislocation or subluxation [25]. Compression from the peroneus longus on the peroneus brevis is implicated in injury at the vascular watershed region [25]. Etiologic factors for peroneal tendon tears include compression of the peroneus brevis between the peroneus longus tendon and the posterior fibula, subluxation/dislocation of the tendons, diminished blood supply in the watershed region, acute change in direction around the fibula, and ankle instability/varus heel [25]. Peroneal tendon tears are frequently associated with peroneal tendon instability with subluxing peroneal tendons impinged by a sharp posterior ridge of the fibula [18].

Most tendon tears occur in the peroneus brevis tendon, at the level of the fibular groove [25]. Less common are tears of the peroneus longus tendon, which usually occur at the peroneal tubercle [25]. Peroneus brevis and peroneus longus tendon tears are often longitudinal in the tendon and typically are seen in chronic situations [25]. Peroneal tendon tears without tendon subluxation are not common, especially in young people, and may be overlooked [18]. Acute tendinitis may result from overuse, predisposition from a varus hindfoot, or stenosis within the peroneal tunnel from a peroneus quartus muscle or low-lying peroneus brevis muscle belly [25]. Tears may be the result of inversion injuries or injury causing tendon subluxation or dislocation [25]. There is a correlation between peroneal tendinosis and ankle sprain trauma, with ligament injuries associated with further complications [19].

SPR injuries are characterized according to the Ogden classification [53]: * Grade I: Partial avulsion of the SPR from the distal fibula, allowing subluxation of the tendons [53]. * Grade II: Separation of the SPR from the distal fibrocartilaginous rim; in this case, the tendons pass between the SPR and the rim [53]. * Grade III: Frank cortical avulsion of the SPR from the distal fibula, forming the classic rim fracture [53]. * Grade IV: SPR failure at the calcaneus instead of the fibula [53].

Peroneal tendon injuries at the level of the ankle should be differentiated from Iselin disease, which is a traction apophysitis seen in the pediatric population and results from repetitive traction of the peroneus brevis at its attachment at the base of the fifth metatarsal [53]. The differential diagnosis of lateral fifth metatarsal pain in the pediatric population includes symptomatic os vesalianum, a rare accessory bone adjacent to the fifth metatarsal in the substance of the peroneus brevis tendon [53].

Classification

Longitudinal Split Tears: Longitudinal split tears of the peroneus brevis are usually found within the retromalleolar sulcus, indicating that they are likely due to mechanical trauma in this region [18]. The splitting of the peroneal tendon develops through a mechanical mechanism with the central portion of the longitudinal split centered over the distal tip of the fibula in the fibular groove [18].

Peroneus Brevis Anatomical Variations: Anatomical variations of the peroneus brevis tendon have been classified into three main types on the basis of the attachment to the calcaneus, the cuboid, or the peroneus longus tendon [22]. The peroneocalcaneal variant is the most common anatomical variation of the peroneus brevis tendon and has been classified into six subtypes [22]. In Type V peroneus brevis anomalies, the tendon originates from the distal third of the peroneus brevis and divides into three slips, which insert on the lateral aspect of the calcaneus posterior to the inferior peroneal retinaculum [22]. In Type VI peroneus brevis anomalies, the peroneus brevis has three separate muscle bellies and tendons [22]. The most common anomaly of the peroneus brevis is an additional tendinous slip, without anomalous muscle tissue, that passes through the peroneus tertius and inserts either on the long extensor of the fifth toe at the proximal phalanx or on the shaft of the fifth metatarsal [22]. LeDouble found a well-developed slip in 22 per cent of cadavera and a vestigial one in an additional 13 per cent [22].

Other Considerations: Detachment of the inferior peroneal retinaculum, peroneus longus tendon dislocation, and entrapment by a split lesion represent a new complex entity [32].

Clinical Presentation

Acute Tendinitis

Patients with acute tendinitis present with swelling and pain in the lateral hindfoot or ankle [25]. Physical examination reveals swelling and pain with palpation, and may demonstrate reduced strength [25]. MRI findings in these cases show fluid within the peroneal tendon sheath [25].

Tendon Tears or Ruptures

Symptoms of tendon tears are similar to those of tendinitis [25]. Physical examination is also similar to tendinitis, but subluxation or dislocation may be provoked during examination with eversion against resistance [25]. MRI reveals longitudinal tears in the tendon, although these can be confused with a peroneus quartus muscle [25]. If pain on the posterolateral aspect of the ankle is refractory, a peroneal tendon tear should be considered [18]. The tear of the peroneus brevis tendon could occur in the 25–15° range of plantar flexion as the peroneus longus impinged against the tip of the fibula and as the peroneus brevis impinged against the lateral wall of the peroneal groove or against the [18].

Dislocation or Subluxation

Physical examination reveals variable pain and swelling depending on the acuteness of the injury [25]. Dislocation or subluxation may be elicited with ankle rotation or with forcing the foot from a position of inversion and plantar flexion to a position of eversion and dorsiflexion [25]. Radiographs may reveal an avulsion fracture of the distal fibula (rim fracture) at the insertion of the superior peroneal retinaculum [25]. The diagnosis of dislocation or subluxation is clinical, and additional studies are often not needed [25].

Investigations

Plain radiography: Radiographs are usually negative for peroneal tendon subluxation, though a "fleck" of bone may be seen off the posterior distal fibula in grade 3 injuries [40]. Plain films may demonstrate a rim fracture of the lateral aspect of the distal fibula in cases of peroneal tendon subluxation [38]. Additionally, radiographs may reveal an avulsion fracture of the distal fibula at the insertion of the superior peroneal retinaculum [25].

MRI: MRI reveals longitudinal tears in the peroneal tendon, but these findings can be confused with a peroneus quartus muscle [25]. False-positive results showing longitudinal tears are common with MRI [38]. The modality may demonstrate displacement of peroneal tendons anterolateral to the retrofibular region [38]. MRI can be used to identify injury to the superior peroneal retinaculum, as well as identify anomalous structures such as the peroneus quartus or a low-lying peroneal brevis muscle belly [40]. Kinematic MRI of the ankle moving from dorsiflexion to plantar flexion has been suggested to be superior to static imaging because the pathologic process is position dependent [40].

Ultrasound: Ultrasound is useful as a dynamic tool to evaluate peroneal tendon subluxation or dislocation [38]. Ultrasonography has been reported to be effective for dynamically evaluating peroneal tendon subluxation [40]. Dynamic ultrasound imaging has been described for intrasheath instability of peroneal tendons [24]. Ultrasound diagnosis of peroneal tendon tears has been correlated with surgical findings [21].

CT: CT analysis has been used for peroneal tendon injuries [21].

Other Considerations: The diagnosis of peroneal tendon subluxation is clinical, and additional studies are often not needed [25]. Cadaver correlation of peroneal tendon changes with magnetic resonance imaging has been performed [21].

Treatment

Non-Operative

Chronic peroneal tendinosis or tenosynovitis is initially managed with activity modification, NSAIDs, a lace-up ankle brace, and physical therapy [38]. For localized inflammation and tendinitis at the peroneus longus tendon associated with the os peroneum, prolonged immobilization in a cast and oral anti-inflammatory medication are recommended [56].

Operative

Indications: Tenosynovectomy, débridement, and repair of degenerative tears are indicated for peroneal tendon pathology, with degenerative tears usually involving the peroneus brevis [38]. Early treatment of longitudinal splits reduces the risk of progression to full tear [38]. Excision and tenodesis are required when there is a complete rupture or severely degenerative tendon (>50%) that prohibits repair [38]. For chronic reproducible tenderness in the plantarlateral aspect of the lateral midfoot despite conservative treatment, debridement of the peroneus longus tendon, removal of the os peroneum, and tenodesis of the peroneus longus to the peroneus brevis may be indicated [56]. Groove deepening is indicated if there is a shallow fibular groove, and peroneal retinacular repair is indicated if there is evidence of tendon subluxation [38]. Chronic peroneal subluxation or dislocation requires repair or reconstruction of the superior peroneal retinaculum (SPR) and fibular groove deepening [38]. Acute peroneal subluxation or dislocation requires SPR repair or reconstruction [38]. If there is no viability of the proximal musculature for peroneal tendon repair, a tendon transfer of the flexor hallucis longus (FHL) is a salvage operation that can restore some active function without expectation of normal function [38]. More than 50% degeneration of both peroneus longus and brevis requires excision of both tendons [38].

Surgical Approach / Technique: Reattachment of the superior peroneal retinaculum and the bone block procedure both offer satisfactory results for recurrent peroneal tendon dislocation with low rates of recurrence and complications [14]. The advantages of the minimally invasive approach for intrasheath subluxation include better cosmetic results, minimal soft tissue trauma, decreased postoperative pain, early mobilization, faster postoperative recovery, less peritendinous fibrosis, and less subjective tightness at the peroneal tendons [45]. If the cuboid tunnel is constricted during os peroneum surgery, it may be enlarged with a small osteotome and rasp [56]. Postoperative care for os peroneum debridement involves a non-weight-bearing cast for 4 weeks, followed by protected weight bearing in a walking boot, with formal physical therapy starting at 8 weeks [56].

Reconstruction and Transfer: Good results are reported with both lateral transfer of the FHL or flexor digitorum longus (FDL) and allograft for peroneal tendon defects [38]. Allograft may be used if peroneal muscles demonstrate adequate excursion at the time of surgery with minimal atrophic change to the muscle [38]. In the younger, more active patient population, the use of an allograft reconstruction can be considered [38]. For hindfoot varus associated with peroneal tendon pathology, a Dwyer osteotomy (lateral closed-wedge osteotomy of the calcaneus) limits the risk of recurrent tears and continued pain [38].

Tendoscopy: Tendoscopy of the peroneal tendons is an effective and minimal invasive management tool that can be indicated in many peroneal disorders [4]. A study found good clinical outcomes in patients with peroneal tendon disorders treated with peroneal tendoscopy [8]. On the basis of the current literature available, there is poor evidence (grade Cf) in support of peroneal tendoscopy for the common indications [3]. Operative results were uniformly good in patients with retrofibular pain treated with endoscopic management, regardless of whether tendon tears, tenosynovitis, or no pathology were found [18].

Complications

Other Considerations: Clinical outcomes reflect the correlation between peroneal tendinosis and ankle sprain trauma, with ligament injuries associated with further complications [19].

Recovery

Light activity (weeks): The provided evidence does not specify a typical week range for light activities such as desk work, driving, or light ADLs.

Full activity (months): The provided evidence does not specify a month range for full activity, including manual work, sport, or full ROM/strength return.

Complete recovery / outcome plateau (months): The provided evidence does not specify a month range for complete recovery or outcome plateau.

Rehabilitation protocol: The provided evidence does not detail specific PT phasing, immobilisation duration, weight-bearing/ROM progression, or sling/brace removal timing.

Functional milestones: The provided evidence does not report validated PROM trajectories or specific outcome-measure benchmarks.

Other Considerations: Peroneal tendoscopy yields good clinical outcomes for peroneal tendon disorders [8]. For recurrent peroneal tendon dislocation, tendoscopic peroneal retinaculum repair enables an earlier return to sports than the open procedure [77]. Although this tendoscopic approach requires longer operation time and is more technically demanding, it is less invasive and can accelerate return to sports [77]. Both open and tendoscopic procedures offer satisfactory results for recurrent peroneal tendon dislocation, with low rates of recurrence and complications [14]. Long-term stability is possible; one patient maintained a stable, painless ankle with no additional instability fourteen years post-procedure [23]. However, approximately one-quarter of patients experienced recurrent sprains, and nearly half of the cohort was unable to achieve their previous sports performance, particularly athletes and those with calcaneofibular ligament injuries [46]. These results help manage preoperative expectations regarding sports- and work-related outcomes and provide tangible data on the expectable time frame for individual return to sports and work trajectories [75].

Key Evidence

  • [Paper] Symptomatic peroneal tendon injuries can result from both acute and chronic processes. [1] (10.1016/j.csm.2015.06.003)
  • [L5] Peroneal tendinosis and peroneal subluxation are uncommon but lifestyle-limiting conditions that worsen if not properly diagnosed and treated. [2] (10.1016/j.csm.2020.07.005)
  • [L4] On the basis of the current literature available, there is poor evidence (grade Cf) in support of Achilles, flexor hallucis longus, and peroneal tendoscopy for the common indications. [3] (10.1016/j.arthro.2014.02.022)
  • [L4] Tendoscopy of the peroneal tendons is an effective and minimal invasive management tool that can be indicated in many of peroneal disorders. [4] (10.1007/s00167-006-0227-2)
  • [L5] This ESSKA-AFAS consensus statement on the optimal management of peroneal tendon pathologies is the result of international and multidisciplinary agreement combined with a systematic review of the literature. [5] (10.1007/s00167-018-4971-x)
  • [L4] Peroneal tenosynovitis is rarely reported and frequently misdiagnosed, often following inversion injury of the ankle. [6] (10.1016/s0020-1383(01)00051-1)
  • [L5] The aim of this review is to summarise the current understanding of the anatomy and diagnostic evaluation of the peroneal tendons, and to present both conservative and operative management options of peroneal tendon lesions. [7] (10.1302/2058-5241.2.160047)
  • [L4] The study found good clinical outcomes in patients with peroneal tendon disorders treated with peroneal tendoscopy. [8] (10.1007/s00167-016-4012-6)
  • [L4] Peroneal tendoscopy is a safe and effective minimally invasive technique for managing peroneal tendon disorders, associated with significant short-term improvement in clinical outcomes and low complication and failure rates. [9] (10.1177/2325967126s00423)
  • [L4] All patients with peroneal tendon tears had associated intra-articular pathology, with the majority having more than one lesion. [10] (10.1016/j.arthro.2009.05.010)
  • [L4] Peroneal tendoscopy provides good outcomes in the treatment of peroneal tendon pathologies. [11] (10.1016/j.arthro.2016.03.081)
  • [L5] A deficiency in viscoelastic properties of the peroneus longus tendon must be considered in diagnostic and treatment for ankle instability. [12] (10.1007/s00167-012-2273-2)
  • [L5] Further studies are needed and planned to evaluate clinical outcomes after IONT of the peroneal tendons. [13] (10.1016/j.eats.2021.11.002)
  • [L3] Both procedures offered satisfactory results for recurrent peroneal tendon dislocation with low rates of recurrence and complications. [14] (10.1007/s00167-019-05479-2)
  • [L3] Soft tissue procedures offer a satisfactory method of treating peroneal tendon dislocations without any additional risk of reoperation when compared to osteotomy techniques that have potentially greater complication rates. [15] (10.1007/s00167-016-4383-8)
  • [L4] Description of distal peroneal tendon dislocations is limited in the literature. [16] (10.1016/s0020-1383(13)70202-x)
  • [L4] Endoscopic stabilisation of peroneal tendons in a child with open physes gives good functional outcomes without growth plate disturbance. [17] (10.1007/s00167-016-4210-2)
  • [L4] [18] (10.1007/s00402-011-1392-4)
  • [L4] The results reflect the correlation between peroneal tendinosis and ankle sprain trauma, with ligament injuries associated with further complications. [19] (10.1007/s00167-015-3562-3)
  • [L4] Fourteen years post-procedure, the patient maintained a stable, painless ankle with no additional instability. [23] (10.1097/01.blo.0000092976.12414.b0)
  • [Case_report] Detachment of the inferior peroneal retinaculum, peroneus longus tendon dislocation, and entrapment by a split lesion represent a new complex entity that can effectively be reconstructed by partial resection of the split tendon, groove deepening, and transosseous reinsertion of the inferior peroneal retinaculum. [32] (10.1186/s12891-020-03757-6)
  • [L5] The advantages of this minimally invasive approach include better cosmetic results, minimal soft tissue trauma, decreased postoperative pain, early mobilization and faster postoperative recovery, less peritendinous fibrosis, and less subjective tightness at the peroneal tendons. [45] (10.1002/atn2.70249)
  • [L4] However, approximately one-quarter experienced recurrent sprains, and nearly half of the cohort was not able to achieve their previous sports performance, particularly athletes and those with calcaneofibular ligament injuries. [46] (10.1177/03635465251354961)
  • [L4] These results may be helpful in preoperatively managing patients' expectations regarding sports- and work-related outcomes and provide tangible data on the expectable time frame of the individual return to sports and work trajectory. [75] (10.1007/s00167-022-06937-0)
  • [L3] This tendoscopic procedure needs longer operation time and is more technically demanding, but it is a useful procedure, because it is less invasive and can accelerate return to sports. [77] (10.1007/s00167-020-05877-x)

References

[1] Peroneal Tendon Disorders. Clinics in Sports Medicine. 2015. DOI: 10.1016/j.csm.2015.06.003

[2] Peroneal Tendinosis and Subluxation. Clinics in Sports Medicine. 2020. DOI: 10.1016/j.csm.2020.07.005

[3] Foot and Ankle Tendoscopy: Evidence‐Based Recommendations. Arthroscopy. 2014. DOI: 10.1016/j.arthro.2014.02.022

[4] Tendoscopic management of peroneal tendon disorders. Knee Surgery, Sports Traumatology, Arthroscopy. 2006. DOI: 10.1007/s00167-006-0227-2

[5] The ESSKA-AFAS international consensus statement on peroneal tendon pathologies. Knee Surgery, Sports Traumatology, Arthroscopy. 2018. DOI: 10.1007/s00167-018-4971-x

[6] Peroneal tenosynovitis following ankle sprains. Injury. 2001. DOI: 10.1016/s0020-1383(01)00051-1

[7] Peroneal tendon disorders. EFORT Open Reviews. 2017. DOI: 10.1302/2058-5241.2.160047

[8] Functional outcomes after peroneal tendoscopy in the treatment of peroneal tendon disorders. Knee Surgery, Sports Traumatology, Arthroscopy. 2016. DOI: 10.1007/s00167-016-4012-6

[9] Poster 119. Clinical Outcomes of Peroneal Tendoscopy for Peroneal Tendon Disorders: A Systematic Review. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/2325967126s00423

[10] Peroneal Tendon Tears: Associated Arthroscopic Findings and Results After Repair. Arthroscopy. 2009. DOI: 10.1016/j.arthro.2009.05.010

[11] Functional Outcomes of Peroneal Tendoscopy in the Treatment of Peroneal Tendon Disorders. Arthroscopy. 2016. DOI: 10.1016/j.arthro.2016.03.081

[12] The role of the peroneal tendons in passive stabilisation of the ankle joint: an in vitro study. Knee Surgery, Sports Traumatology, Arthroscopy. 2012. DOI: 10.1007/s00167-012-2273-2

[13] In‐Office Needle Tendoscopy of the Peroneal Tendons. Arthroscopy Techniques. 2022. DOI: 10.1016/j.eats.2021.11.002

[14] Reattachment of the superior peroneal retinaculum versus the bone block procedure for the treatment of recurrent peroneal tendon dislocation: two safe and effective techniques. Knee Surgery, Sports Traumatology, Arthroscopy. 2019. DOI: 10.1007/s00167-019-05479-2

[15] Incidence of reoperation and wound dehiscence in patients treated for peroneal tendon dislocations: comparison between osteotomy versus soft tissue procedures. Knee Surgery, Sports Traumatology, Arthroscopy. 2016. DOI: 10.1007/s00167-016-4383-8

[16] Isolated inferior peroneal retinculum tear in professional soccer players. Injury. 2013. DOI: 10.1016/s0020-1383(13)70202-x

[17] Endoscopic fibular groove deepening for stabilisation of recurrent peroneal tendons instability in a patient with open physes. Knee Surgery, Sports Traumatology, Arthroscopy. 2016. DOI: 10.1007/s00167-016-4210-2

[18] Endoscopic management of recalcitrant retrofibular pain without peroneal tendon subluxation or dislocation. Archives of Orthopaedic and Trauma Surgery. 2011. DOI: 10.1007/s00402-011-1392-4

[19] Peroneal tendinosis as a predisposing factor for the acute lateral ankle sprain in runners. Knee Surgery, Sports Traumatology, Arthroscopy. 2015. DOI: 10.1007/s00167-015-3562-3

[21] Campbell S Operative Orthopaedics 4 Volume Set. MULTIPLE Z-PLASTY RELEASE OF A CONGENITAL RING > DISORDERS OF TENDONS > PERONEAL TENDONS.

[22] Congenital abnormalities of the peroneal tendons have been described, but the descriptions have been based primarily on anatomical dissections2'3. There have been few clinical reports on developmental anomalies that caused symptoms"4'5. The following case is an example of that phenomenon.. 1991.

[23] Salvage Reconstruction for Lateral Ankle Instability Using a Tendon Allograft. Clinical Orthopaedics and Related Research. 2003. DOI: 10.1097/01.blo.0000092976.12414.b0

[24] Campbell S Operative Orthopaedics 4 Volume Set. ACHILLES TENDON AUGMENTATION OF SUPERIOR PERONEAL RETINACULUM REPAIR > DISPLACEMENT OF PERONEAL TENDONS.

[25] Aaos Comprehensive Orthopaedic Review 3. Tendon Disorders of the Foot and Ankle > III. Disorders of the Peroneal Tendons.

[32] Successful reconstruction of distal peroneus longus tendon dislocation associated with a split lesion – a case report. BMC Musculoskeletal Disorders. 2020. DOI: 10.1186/s12891-020-03757-6

[38] Miller S Review Of Orthopaedics. PERONEAL TENDONS.

[40] Campbell S Operative Orthopaedics 4 Volume Set. SUTURE ANCHOR REPAIR OF PATELLAR TENDON RUPTURE > REPAIR OF THE SUPERIOR PERONEAL RETINACULUM > FIBULAR GROOVE DEEPENING WITH TISSUE TRANSFER (PERIOSTEAL FLAP) FOR RECURRENT PERONEAL TENDON DISLOCATION.

[45] Endoscopic Retrofibular Groove Deepening and Resection of a Low‐Lying Muscle of the Peroneus Brevis for the Management of Intrasheath Subluxation of Peroneal Tendons Associated With a Low‐Lying Peroneus Brevis Muscle. Arthroscopy Techniques. 2026. DOI: 10.1002/atn2.70249

[46] Clinical Outcomes and Sports Participation After the Modified Broström Procedure in Children and Adolescents With Chronic Lateral Ankle Instability: A 5- to 10-Year Follow-up of 111 Cases. The American Journal of Sports Medicine. 2025. DOI: 10.1177/03635465251354961

[53] Orthopaedic Knowledge Update. Ankle Injuries* > Peroneal Tendon Injuries.

[56] Campbell S Operative Orthopaedics 4 Volume Set. MULTIPLE Z-PLASTY RELEASE OF A CONGENITAL RING > DISTAL PERONEAL LONGUS TENDINITIS ASSOCIATED WITH OS PERONEUM: THE PAINFUL OS PERONEUM SYNDROME.

[75] High return to sports and return to work rates after anatomic lateral ankle ligament reconstruction with tendon autograft for isolated chronic lateral ankle instability. Knee Surgery, Sports Traumatology, Arthroscopy. 2022. DOI: 10.1007/s00167-022-06937-0

[77] Tendoscopic peroneal retinaculum repair for recurrent peroneal tendon dislocation enables earlier return to sports than the open procedure. Knee Surgery, Sports Traumatology, Arthroscopy. 2020. DOI: 10.1007/s00167-020-05877-x

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NC NonCommercial — not for commercial use

Attribution-NonCommercial 4.0 International

Creative Commons Corporation ("Creative Commons") is not a law firm and does not provide legal services or legal advice. Distribution of Creative Commons public licenses does not create a lawyer-client or other relationship. Creative Commons makes its licenses and related information available on an "as-is" basis. Creative Commons gives no warranties regarding its licenses, any material licensed under their terms and conditions, or any related information. Creative Commons disclaims all liability for damages resulting from their use to the fullest extent possible.

Using Creative Commons Public Licenses

Creative Commons public licenses provide a standard set of terms and conditions that creators and other rights holders may use to share original works of authorship and other material subject to copyright and certain other rights specified in the public license below. The following considerations are for informational purposes only, are not exhaustive, and do not form part of our licenses.

Considerations for licensors: Our public licenses are intended for use by those authorized to give the public permission to use material in ways otherwise restricted by copyright and certain other rights. Our licenses are irrevocable. Licensors should read and understand the terms and conditions of the license they choose before applying it. Licensors should also secure all rights necessary before applying our licenses so that the public can reuse the material as expected. Licensors should clearly mark any material not subject to the license. This includes other CC- licensed material, or material used under an exception or limitation to copyright. More considerations for licensors: wiki.creativecommons.org/Considerations_for_licensors

Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

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