Persistent Sore Ankle Might Be Damaged Tendon

May 13, 2009

by Denise Mann Kleinman

COLUMBUS, Ohio—Physicians should consider a possible peroneal tendon injury in patients with refractory lateral ankle pain, suggests a review article in the May 2009 issue of the Journal of the American Academy of Orthopaedic Surgeons.¹

{}“The biggest take home is that if someone has an ankle sprain, there is a whole list of things to think of, and one is a peroneal tendon injury,” said lead author Terrence M. Philbin, DO, the fellowship director of the Orthopedic Foot and Ankle Center in Columbus, Ohio. “Put peroneal tendon injuries in your differential diagnosis, especially in those patients who are not getting better within a month to 6 weeks.”

The index of suspicion should be higher in patients with high arches, as they are more prone to such peroneal tendon injuries, Dr. Philbin told MSKreport.com. Other red flags include

• swelling and tenderness around the outside of the ankle,
• pain behind the anklebone, and
• pain that transmits from the ankle down into the foot.

These injuries often slip under the radar because the patient assumes the injury is a benign ankle sprain, or because the patient visits an urgent care center and lacks follow-up, even if the pain does not subside, according to Dr. Philbin.

Imaging gives best picture of peroneal tendon woes

The best way to diagnose these injuries is with magnetic resonance imaging or ultrasound.

“A thorough history and physical examination, combined with judicious use of imaging techniques, should aid in making the correct diagnosis,” the study authors conclude.

If the condition is diagnosed early, it can often be successfully treated with rest, ice and elevation, anti-inflammatory drugs, casting or bracing and/or physical therapy.

Surgery, however, may be needed if a patient waits too long and a tear occurs.

The non-operative approach is typically best for patients with minimal symptoms and loss of function. “In contrast, higher-demand patients with more loss of function, especially those involved in athletic activities, may benefit from surgical treatment,” the study authors write.

There are currently several surgical techniques aimed at treating peroneal tendon injuries including bone block procedures, groove deepening, subluxation and dislocation, and tissue transfer.

Exactly which surgery is best is still unknown. Dr. Philbin said that the next step is to conduct a prospective, randomized study to determine which surgery is the most effective for repairing the damaged peroneal tendon.

References

1. Philbin TM, Landis GS, Smith B. Peroneal tendon injuries. J Am Acad Orthop Surg. 2009;17:1-12.