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Peroneus Longus Tear

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Ann PT, Jun 28, 2006.

  1. Ann PT

    Ann PT Active Member


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    Hi all!

    Does anyone have experience with peroneus longus tears? I have a colleague who is a distance runner who recently tore hers with an inversion injury to her ankle (confirmed by MRI). At her baseline she has a weak posterior tib with a history of post. tib. tendonitis and plantar fasciitis (neither are active now). Despite these baseline problems, she has qualified for the Olympic Marathon trials four different times! Her pain is from midstance to pushoff in the area of her lateral and plantar calcaneus. Any thoughts on long term consequences and implications for orthotic management? I do not currently know the size of the tear.

    Thanks,
    Ann
     
  2. Peroneus longus tendon tears in a distance runner can successfully be treated conservatively in some cases if the tear (generally a longitudinal split of the tendon) is relatively mild.

    If the tear is new, then try putting her in a cam walker style brace for 4 weeks, with no running. This may allow it to heal if the tear is minor. Icing, using a 2-5 forefoot valgus extension on an orthosis along with some increased valgus wedging on the orthosis may help the pain, but also may, unfortunately, exacerbate her posterior tibial tendinitis.

    Most of these tears do well with surgical repair but this would mean at least 3 months or more of no running. If it were my foot, and the tear did not respond to immobilization, and orthosis modifications, then I would have the surgery done.

    Hope this helps.
     
  3. Atlas

    Atlas Well-Known Member


    The PL tear is obviously the main consideration here. The inversion trauma has obviously increased tensile stress beyond the physiological limit.

    Our job is to remove the workload and tensile stressors from the structure.

    1. If ankle strapping/bracing does not alleviate signs/symptoms, then Kevin's idea regarding the cam sounds good.

    2. Valgus wedging

    3. Short-term, may be good for the tear to stop wearing orthoses until the primary pathology mends.

    4. Strapping for return-to-sport.

    5. Long-term, a cuboid notch to assist/unload the PL. Review rear-foot posting aggression. Forefoot valgus wedging sounds good in theory, but that would not come into play until FF loading. Your mandatory inversion injury would occur closer to HS IMO. Therefore, we want the forces applicable there.
     
  4. Admin2

    Admin2 Administrator Staff Member

  5. wolfgagn510

    wolfgagn510 Welcome New Poster

    I have a patient post-op peroneal tendon repair RIGHT. The longus was ruptured about 9 months so all I could do was suture the remaining porton to the brevis. I tried valgus wedging under the forefoot and rearfoot. Patient developed stress fractures to metatarsals 4 and 5. Now has lateral coloumn pain and c/o inability for first met to touch the ground, decreased push off strength and ankle rolling out.

    Here is a few measurements:
    RCSP 5 degree varus Right
    RCSP 5 degree valgus Left
    Forefoot to Rearfoot about 5 degrees valgus b/l
    Slight met adductus

    I don't know if he can be controlled/helped with an orthotic. Any orthoses suggestions? No matter how much I post or build up laterally his first ray will not go down with weight bearing and when he walks he has a distinct supinatroy moment midstance.

    Should I go to a custum ankle brace? Help please!
     
  6. drsarbes

    drsarbes Well-Known Member

    Hi Ann:
    I have a couple of pictures of PL tears in case you have never seen these, and 1 post op.
     

    Attached Files:

  7. drsarbes

    drsarbes Well-Known Member

    ooooooooops!

    I just saw how OLD this original post was!

    Well, better late than never.

    Steve
     
  8. It doesn´t matter great pictures thanks for posting them Steve
     
  9. efuller

    efuller MVP

    One test I do may help you. I call this the maximum eversion height test. Patient is standing and you ask them to pronate while observing the lateral foot. Some feet with laterally deviated STJ axes will also have very little range of motion available. (Lat dev STJ axis tends to cause peroneal tendon pathology from increased use.) As you note the height of eversion available, you should check the height of the valgus wedges that you've added. If the wedge is bigger than the height of range of motion available you will get very high lateral column loads. When you have a low amount of eversion available, you can use a lateral heel skive to create a valgus wedge effect in the heel as well as use as much forefoot wedge as they can tolerate. If this is not enough, then you might want to go to something like a brace that can apply a pronation moment from above.

    An inverted RCSP can be caused by two things. Lack of range of motion in the direction of eversion or a foot that reaches equilibrium at the STJ at an inverted position not at its end of range of motion. Try the Coleman block test, or the maximum eversion height test, to distinguish between these two very different foot types.

    Eric
     
  10. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    Longitudinal Tears of Peroneus Longus and Brevis Tendons: A Gouty Infiltration.
    Radice F, Monckeberg JE, Carcuro G.
    J Foot Ankle Surg. 2011 Aug 3. [Epub ahead of print]
     
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    Long-Term Results of Debridement and Primary Repair of Peroneal Tendon Tears
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    Rehabilitation after surgical treatment of peroneal tendon tears and ruptures
    Pim A. D. van Dijk , Bart Lubberts, Claire Verheul, Christopher W. DiGiovanni, Gino M. M. J. Kerkhoffs
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    Biomechanical Cadaveric Evaluation of Partial Acute Peroneal Tendon Tears.
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