Peroneal tendon problems

Last evidence check and revision September 2007


peroneus brevis tear

Peroneus brevis tear caused by abrasion on the edge of the labrum as an unstable tendon subluxes laterally.
Other tears are probably caused by compression of brevis against the fibula by longus.

Peroneus brevis tears are

peroneal tendon pathology

Peroneus longus tears are:

About 10% of patients have combined tears of both tendons.

Pain at the point where the peroneus longus tendon turns into the cuboid groove is sometimes known as “painful os peroneum syndrome” (POPS) (Sobel et al 1994). This may be due to:


Tearing or detachment of the SPR may allow the tendons to prolapse laterally, with pain, swelling and weakness of eversion. The brevis tendon is often torn – it is thought it may be lacerated by the sharp edge of the fibular groove. A shallow fibular groove is commoner in patients with instability, as is an abnormally distal origin of the peroneus brevis muscle belly. There is a strong association with ankle instability.

Eckert and Davis (1976) described three types of retinacular deficiency. In practice almost all instability is type 2.

peroneals normal diagram

Normal peroneal tendons in cross-section behind the lateral malleolus
R - retinaculum
L - labrum
B - brevis
L - longus

peroneal instability1

Type 1
Retinaculum and labrum are completely avulsed from the fibula. The tendons sublux subcutaneously. A tear of brevis is often present.

peroneal instability2

Type 2
Retinaculum and labrum are avulsed in continuity with a flap of fibular periosteum, forming a sub-periosteal pocket into which the tendons sublux. Das De pointed out the similarity to the Bankhart lesion in the shoulder

peroneal instability3

Type 3
Similar to type 2 but the labrum is avulsed with a small flake of bone