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Peroneal Tear confirmed via MRI
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Just got a quick verbal report on my MRI I had yesterday on my L ankle confirming what I think he said was split tear in my peroneal brevis tendon. I will talk to the ortho who ordered the MRI on Monday but from all of my research it appears surgery is the most effective way to deal with this.

Guess its a good time of year to have surgery but I may have to put my half marathon off that is in February.

RROOF? any thoughts? I am in MA so if there are any well known sports centric surgeons I should seek a 2nd from please advise.

Thanks!

"Base training is bull shit" - desertdude
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Re: Peroneal Tear confirmed via MRI [thirstygreek] [ In reply to ]
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Is it torn all the way through?

I have an 8mm tear in an ankle tendon at the moment. I am treating it with nitroglycerin patches and aggressive PT including ultrasound and lots of stretching/strengthening. I might consider a platelet concentrate injection if the nitro doesn't do it for me.

Tendons can heal -- it takes time. Nitro is supposed to improve blood flow to the area and help healing. But if it's torn through, you're sunk.

Either way, sorry to hear this. I know first hand how bad it sucks. I found out about mine 6-weeks out from an IM and had to drop out of the race. :(
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Re: Peroneal Tear confirmed via MRI [squesen] [ In reply to ]
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I havew used the Nitro patches and they do work!
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Re: Peroneal Tear confirmed via MRI [thirstygreek] [ In reply to ]
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I first read that as "Perineal Tear" and thought really bad thoughts.

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Re: Peroneal Tear confirmed via MRI [thirstygreek] [ In reply to ]
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Depends on the size of the tear if surgery is warranted. Just repaired one Thurs (4.2cm long). Fixed her other side 4 years ago! My very rough rule of thumb is that a longitudinal peroneus brevis (mostly commonly, occasionally the longus) tear less than 2.5 cm (about an inch), I cast/immobilize, then PT. Tears larger than 2.5 cm - primary repair (and usually augmentation with Pegasus, graft jacket, etc.). Threshold for surgery varies for a variety of reasons, with most on this board leaning closer to surgical repair. Best of luck! PM sent as well.

____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD
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Re: Peroneal Tear confirmed via MRI [LuckyMe] [ In reply to ]
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In Reply To:
I first read that as "Perineal Tear" and thought really bad thoughts.

x2...

Jodi
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Re: Peroneal Tear confirmed via MRI [Jodi] [ In reply to ]
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Appreciate the advice! I will know more Monday. I would like to try the immobilize and PT but only if there is a high chance of recovery. I will also suggest the nitro patches as well. Anything to increase blood flow.

Are plasma injections covered by most HMOs?

rroof PM sent, thank you.

"Base training is bull shit" - desertdude
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Re: Peroneal Tear confirmed via MRI [Jodi] [ In reply to ]
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In Reply To:
In Reply To:
I first read that as "Perineal Tear" and thought really bad thoughts.

x2...

Jodi
X3. That's the only reason I opened the thread!
Last edited by: LoDewey: Oct 22, 10 19:34
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Re: Peroneal Tear confirmed via MRI [LoDewey] [ In reply to ]
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seemed like it was getting a lot of views for a thread on a tendon

"Base training is bull shit" - desertdude
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Re: Peroneal Tear confirmed via MRI [thirstygreek] [ In reply to ]
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Got a call from the ortho today, he didn't mention size of the tear but he recomends surgery. He mentioned due to the fact I am an active person this would be this best route. He said I could bear weight on the "cast" just not at first. I would like more details. He does operate out of New England Baptist which was good news. I am just not keen on anesthesia but I don't know if just going with the nerve block is a smart idea...6-8 week Pwb/wbat will be tough, maybe he will be open to active recovery.

"Base training is bull shit" - desertdude
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Re: Peroneal Tear confirmed via MRI [thirstygreek] [ In reply to ]
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Bump

"Base training is bull shit" - desertdude
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Re: Peroneal Tear confirmed via MRI [thirstygreek] [ In reply to ]
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Slightly ahead of you with the tear. My tendon was torn into three sections. Had surgery back on Sept 17th and will have the cast off Nov 3. I was told to keep weight off and have. Anxious for next appointment to see how it is progressing and if I will be able to start to put weight on it.

Devinci
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Re: Peroneal Tear confirmed via MRI [thirstygreek] [ In reply to ]
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Platelet rich plasma injections (and or entities like Nitro patches) are not going to help much in a high grade longitudinal tear of the tendon. They are best utilized for chronic cases/tendinosis. Speedy healing. Don't fret the anesthesia - I can repair these with IV sedation/local field block, but other surgeons prefer general anesthesia. Most anesthesia people do poor ankle blocks though, but are super skilled intubators!

____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD
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Re: Peroneal Tear confirmed via MRI [rroof] [ In reply to ]
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Do you follow the 2 week nwb protocol as well? I have read I may be able to get on the trainer as soon as 2-3 weeks post op

"Base training is bull shit" - desertdude
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Re: Peroneal Tear confirmed via MRI [thirstygreek] [ In reply to ]
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In Reply To:
Do you follow the 2 week nwb protocol as well? I have read I may be able to get on the trainer as soon as 2-3 weeks post op


For the most part, yes. Depends on several factors: patient trust (triathletes are a HUGE red flag!), how big the tear was, how old and was there mucinous degradation or significant tendon debridement, whether a graft was used, etc. Don't rush your recovery as tendons heal slow, but the "surgery" will appear to be good to go way before the slow healing peroneal tenodn is. Listen to your surgeon and follow his and your therapists (likely) instructions carefully.

____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD
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Re: Peroneal Tear confirmed via MRI [rroof] [ In reply to ]
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Could a Peroneal Tear be diagnosed with ultrasound? My longus and brevis seem to be bothering me for about two years. It feels more like an ankle sprain with point tenderness just distal to the lateral malleolus. ART helped releasing it, but it comes right back.
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Re: Peroneal Tear confirmed via MRI [regis] [ In reply to ]
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Thanks rroof ! Going to be 2 weeks before procedure because I dont want to be on crutches in NYC when I am rooting for my wife at the marathon

"Base training is bull shit" - desertdude
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Re: Peroneal Tear confirmed via MRI [regis] [ In reply to ]
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In Reply To:
Could a Peroneal Tear be diagnosed with ultrasound? My longus and brevis seem to be bothering me for about two years. It feels more like an ankle sprain with point tenderness just distal to the lateral malleolus. ART helped releasing it, but it comes right back.


Yes, diagnostic ultrasound is a decent imaging modality for tendon pathologies, esp the peroneals, but is very operator dependent. The more common injury would be the peroneus brevis (esp with a 2 year history) that lies deep to the longus. Point tenderness is generally from right behind to inferior of the lateral malleolus or with resisted eversion. Some subtle localized edema is usually noted. An MRI shows far greater detail though which can be important in deciding between treatment options (i.e. surgery). Had a very small, 1.5cm tear just today in a very overweight, sedentary 24 year old female for example on MRI - definitely not a surgical candidate. 2 weeks ago, a 4cm tear in the brevis in an active runner - quite the opposite, although the symptoms/clinical exam were almost identical.

____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD
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Re: Peroneal Tear confirmed via MRI [rroof] [ In reply to ]
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Is there anyone in Indianapolis you would recommend to help with this? I think you are two hours away.
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Re: Peroneal Tear confirmed via MRI [rroof] [ In reply to ]
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rroof,

thanks for the advice and time...it has been a while and I had the MRI and the surgeon said "well you are athletic so I think surgery is the best option" It was very quick and I went along but surgery is still 3 weeks away!

Since the MRI I obviously have ceased all running and have kept up swimming and some light spinning as it causes no discomfort. The problem is for the past almost three weeks I have had NO pain, I occasional feel a little twinge of like pressure right at the lateral malleous but its not pain and its rare. Last week I was shooting hoops with my 13yo at the gym to warm up for a weight training session and before I knew it I was going all out 100% jumping shooting etc with ZERO pain. I did this twice. What this has me thinking is, has the tendon begun to heal? Is it possible on its own? I am a vegan who eats very well and generally heal rapidly and recover from workouts quickly (I know anecdotal)

I misplaced the MRI reading which I will find but it read split tear of peroneal longus and then its specified from where to where...I have linked to an album with images from the MRI, if you have a sec can you look? I am contemplating a second opinion but I need to find someone who works with athletes.

http://picasaweb.google.com/thirstygreek/Misc#

Thanks a ton

"Base training is bull shit" - desertdude
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Re: Peroneal Tear confirmed via MRI [thirstygreek] [ In reply to ]
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Couple of things: I find that vegans heel SLOWER than not, on avg (just some FYI). Sure, it could have healed (but not in 3 weeks). Again, depends on the size of the tear (among other factors) on whether I would rec surg. You saw someone and he did, so for now, stay with the only person qualified to give you a real answer! Now, nothing wrong with another opinion of course.

edit: just saw your posted MRI. You do have some peroneal thickening/fibrosis just behind the lateral malleolus, but you only have about 3 sagittal images there showing the peoroneal(s) (really need to see the whole exam, T1/T2 weighted images, etc.) to really get some more info.

____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD
Last edited by: rroof: Nov 21, 10 13:56
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Re: Peroneal Tear confirmed via MRI [rroof] [ In reply to ]
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Ok thanks, my 'evidence' of faster healing is based on my faster recovery since turning vegan as opposed to prior years, nothing more.

As for the images does the tear look large?

"Base training is bull shit" - desertdude
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Re: Peroneal Tear confirmed via MRI [thirstygreek] [ In reply to ]
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In Reply To:
Ok thanks, my 'evidence' of faster healing is based on my faster recovery since turning vegan as opposed to prior years, nothing more.

As for the images does the tear look large?

I really can't tell the size (first on my iPhone, now laptop) from just 3 sagittal T1 images since the brevis and longus (and occasionally tertius) run together and can be misdiagnosed as a tear.

From what I can see, no - looks small/chronic. Much like a rotator cuff tear/injury in the shoulder, you can function at a pretty high level though, despite the tear. Does that mean you need surgery? Again, for you to discuss with your surgeon.

____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD
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Re: Peroneal Tear confirmed via MRI [rroof] [ In reply to ]
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thanks rroof, I am seeking an appointment with a foot ankle guy at MGH

"Base training is bull shit" - desertdude
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Re: Peroneal Tear confirmed via MRI [thirstygreek] [ In reply to ]
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So just now reading this as I am having an MRI today for peroneal trouble. Curious as to how this turned out. Did you have the surgery? Was it successful? How long was recovery?
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Re: Peroneal Tear confirmed via MRI [rilesgregb] [ In reply to ]
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No surgery I took three months off then came back slow and since then I have had two instances of tendonitis and now nada. Ate a lot of anti inflammatory foods and did lots of lower extremity eccentric movements.

"Base training is bull shit" - desertdude
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Re: Peroneal Tear confirmed via MRI [thirstygreek] [ In reply to ]
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Sounds like you made the right choice. Surgery sounds pretty tough to recover from. Hoping they don't discover anything too alarming on me. Mine's been getting me on the outer portion of the foot where the tendon meets the cuboid. Just curious did you do anything during the three months? No running or cycling at all? Thanks for the response.
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Re: Peroneal Tear confirmed via MRI [rilesgregb] [ In reply to ]
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I didnt do much no, light spinning but no hard intervals, pushing off of the wall in swimming bothered it a lot so I didnt even do much of that

"Base training is bull shit" - desertdude
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Re: Peroneal Tear confirmed via MRI [LoDewey] [ In reply to ]
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LoDewey wrote:
In Reply To:
In Reply To:
I first read that as "Perineal Tear" and thought really bad thoughts.

x2...

Jodi
X3. That's the only reason I opened the thread!

I was wondering what weird doctor gave him an MRI for it.
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Re: Peroneal Tear confirmed via MRI [thirstygreek] [ In reply to ]
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Just a question, what did it feel like? Can you walk? Does it feel like a bruise? Was it spontaneous?
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Re: Peroneal Tear confirmed via MRI [cmonster] [ In reply to ]
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Um, I can walk. This all started around the middle of Feb. At least that's when I first noticed something wasn't right. I continued to run and tried to ignore it, but then on March 7th I went out for a pretty easy 6 mile run and my foot hurt for most of the day to where I was limping. I went to the Dr. He diagnosed plantar and peroneal tendonitis. I believe the plantar was first and because of that I altered my stride to the outside (I'm a supinator anyway) and that made my foot hurt by the 5th metatarsal. I was training to run a marathon on the March 17th. The doctor told me I could do it. Wish I hadn't. Limped in over an hour longer than my previous marathon. I took two weeks off and went to PT religiously and did the exercises daily. I also iced and took anti-inflamatories. Tried to run with the blessing of the PT after two weeks. Did an easy 3 on Mon. and Wed. and then upped it to 4 on Friday. Then that Sunday, the April 7th I tried to run 6 miles and only made it 5 until it started to hurt and had to walk the last mile in. I felt so defeated. Went to the PT the following day and she said I tried to do too much too fast. They put me in a boot and ordered and MRI. I had the MRI yesterday afternoon and will get the results tomorrow. The foot feels okay. Not a lot of pain, but it feels weak. When I try to do the balancing, I am really weak on that side. That probably contributed to my problem. I am supposed to run the NYC Marathon in November as I got the boot last year because of Sandy. Really frustrated. I've been riding the bike and the bike trainer. The Dr and PT said I could as long as I stayed in the seat and didn't clip in. I'm really a runner and not a cyclist, but I do like to cycle to cross train. That's my sad story during a sad week in the running world.
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Re: Peroneal Tear confirmed via MRI [rilesgregb] [ In reply to ]
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I asked because I have been experiencing the same pain as you described. I have what feels like a terrible bruise right at the peroneal attacment anr it extends I've the baxk of my heel though with some achilles soreness. Ultrasound shows nothing so I've treated with voltaren gel. Its works great but I get rewlly sore 5 mi into a run. I have a half iron thus weekend so we will see. Ice ane nsaids for now. I also have battled PF and have been running on the outside of my foot.
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Re: Peroneal Tear confirmed via MRI [rroof] [ In reply to ]
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hey,
ive just got my MRI back saying i have a longitudinal split tear of my peroneus brevis from my inferior tip of lateral malleolus to the peroneal trochlea. i also have a partial tear of my calcaneal attachment of the lateral root of the stem of my extensor retinaculum which measures 9mm AP X 5mm transverse?
i also have tendinopathy and tenosynovitis.
i had the peroneus brevis repaired for the same injury 7mnths ago and ankle stabilisation (atfl rupture). what do you recommend as the best approach?
In Reply To:
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Re: Peroneal Tear confirmed via MRI [nursekimmy] [ In reply to ]
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I'm assuming your asking rroof, for what its worth its been years now and I never had the surgery and have been training like a maniac for years. once I was pain free it was a slow return with eccentric exercises.

"Base training is bull shit" - desertdude
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Re: Peroneal Tear confirmed via MRI [nursekimmy] [ In reply to ]
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nursekimmy wrote:
hey,
ive just got my MRI back saying i have a longitudinal split tear of my peroneus brevis from my inferior tip of lateral malleolus to the peroneal trochlea. i also have a partial tear of my calcaneal attachment of the lateral root of the stem of my extensor retinaculum which measures 9mm AP X 5mm transverse?
i also have tendinopathy and tenosynovitis.
i had the peroneus brevis repaired for the same injury 7mnths ago and ankle stabilisation (atfl rupture). what do you recommend as the best approach?
In Reply To:

Are you saying your current injury(ies) is on the same side you had repaired 7 months ago, or the other side? If you have a longitudinal tear that long (well over 2.5 cm by your description), then it isn't likely to heal even with aggressive immobilization/PT/time. :(

____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD
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Re: Peroneal Tear confirmed via MRI [rroof] [ In reply to ]
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Same side! Oh bummer :(
Do they just repair it again? Or is it different the second time round??
Thank you for replying really appreciate it!
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Re: Peroneal Tear confirmed via MRI [nursekimmy] [ In reply to ]
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nursekimmy wrote:
Same side! Oh bummer :(
Do they just repair it again? Or is it different the second time round??
Thank you for replying really appreciate it!

You are definitely going to want an opinion or two regarding your MRI and clinical findings. Suggest you start with your original surgeon as well and go from there. There are also newer grafts, etc. that can make the repair "stronger". Then, you need to figure out what you are doing to cause this injury pattern.

____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD
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Re: Peroneal Tear confirmed via MRI [rroof] [ In reply to ]
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Thank you for getting back to me again! Very kind of you :)
Well I play soccer competively and I did have a peroneus brevis tear (not sure whether it was longitudinal or transverse) when I was 15 as well..7 years ago which I had surgically repaired also!
But that healed fantastically! It's just this time after having a very bad acute injury and then having the ankle stabilisation and tendon repair it hasn't been the same. I keep getting persistent oedema and bruising and the pain can be quite horrid. Sometimes when I drive or walk on sand etc I get intermittent sharp 8/10 pains around the peroneal tendon region and then they go away completely. To play soccer is painful to warm up, I still roll my ankle even with a brace on sometimes! And very painful when i stop running etc
I don't want another surgery :( but do you think it's worth doing again? A Physio I spoke too thinks Physio might help me get rid of the pain? Is this a waste of time?
Sorry I'm just wondering because I only have a few weeks off before pre season starts again and plus I'm a registered nurse and I need to think about time! Haha so sorry to bother you with so many questions!
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Re: Peroneal Tear confirmed via MRI [nursekimmy] [ In reply to ]
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Just wondering how your issues was resolved. I tore my peroneal completely, so i just had surgery a week ago and it already sucks. not so much the pain, but the inability to do anything and the knowledge that i have another week in this soft cast and then 4-6 weeks in a hard cast then 6 more weeks in a boot! Oh, the thought just kills me. Do you have any idea how long it is before one is able to really get back to running and such? Hope your peroneal issue has been resolved.
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Re: Peroneal Tear confirmed via MRI [mfisch69] [ In reply to ]
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Had a partial tear four years ago. Wore a boot for almost 8 weeks (wore out one boot with all the walking I did) and gradually came out of it. No running. I stopped biking because I felt it wasn't helping. After 13 weeks, I began easy biking on the trainer. Almost 4 weeks later, I began a walk-jog-walk routine on the treadmill. No problem today.
Last edited by: Billyk24: Sep 27, 16 18:58
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