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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
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The most frequent heel lift height to treat Achilles tendonitis
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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. -
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. -
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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! -
Hi Ann:
I have a couple of pictures of PL tears in case you have never seen these, and 1 post op.Attached Files:
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ooooooooops!
I just saw how OLD this original post was!
Well, better late than never.
Steve -
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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 -
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Audit of Foot and Ankle Surgeons’ Management of Acute Peroneal Tendon Tears and Review of Management Protocols.
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Wagner E et al
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Peroneus longus tendon rupture: A case report.
Koh D et al
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Minimally invasive tenodesis for peroneus longus tendon rupture: A case report and review of literature.
Nishikawa DRC et al
World J Orthop. 2020 Feb 18;11(2):137-144
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Diagnosis and Operative Treatment of Peroneal Tendon Tears
Natalie R. Danna MD, James W. Brodsky, MD
Foot & Ankle Orthopaedics April 9, 2020
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Clinical Outcomes of Peroneal Tendon Tears: A Systematic Review
Nathaniel P. Merce et al
March 09, 2021
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Clinical Outcomes of Peroneal Tendon Tears: A Systematic Review
Nathaniel P Mercer et al
J Foot Ankle Surg. 2021 Mar 10
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Preoperative Gait Analysis of Peroneal Tendon Tears
Noah Chinitz et al
Foot Ankle Int. 2021 Oct 1
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Anatomical Factors Which Influence the Formation of Peroneal Tendon Tears: A Retrospective Comparative Study
Tacettin Ayanoglu et al
April 23, 2022
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Anatomical Factors Which Influence the Formation of Peroneal Tendon Tears: A Retrospective Comparative Study
Tacettin Ayanoglu et al
J Foot Ankle Surg. 2022 Apr 25
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Peroneus longus tear associated with os peronum fracture: review of current anatomic and surgical concepts regarding two case reports.
SérgioSoaresAngelaSeidelMohandAgaouaHoussemedineKouki
Foot & Ankle Surgery: Techniques, Reports & Cases; 21 July 2022, 100229
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Peroneus Quartus, An Alternative for The Repair of Peroneus Brevis Tendon Tear
Anne Cossogue DPM et al
Foot & Ankle Surgery: Techniques, Reports & Cases 1 March 2023, 100273
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Minimally Invasive Peroneal Tenodesis Assisted by Peroneal Tendoscopy: Technique and Preliminary Results
Rodrigo Simões Castilho et al
Medicina (Kaunas). 2024 Jan 5;60(1):104.
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MRI findings of peroneal tendon tears do not necessarily correlate to clinical findings in paediatric and adolescent patients
Barkha Chhabra, Nikhil Gattu & Indranil Kushare
International Orthopaedics Article: 29 February 2024
<
The most frequent heel lift height to treat Achilles tendonitis
|
Weightlifting squat: barefoot or shoes?
>
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