Since February I started having peroneal tendon issues in my left ankle. I tried to analyze what caused it and it seems like I used arch supports that were too high and made me supinate since I also had some mild tendonitis on my right ankle for a few weeks.
After getting shockwave treatments I got another MRI and ultrasound to see what my progress was and the results are conflicting and the suggestion for surgery seems drastic. She suggests I get a Brostrom-Gould to repair my ATFL and also a peroneal tendon repair. I definitely would like to get surgery over with and finally start recovering and beginning training again but I don’t want to get a major surgery that could leave my ankle worse off if I don’t need it.
Right now I don’t have any pain or ankle instability. Do tendon tears usually feel very painful? Even in the early stages of the tearing I only felt stiffness on the bottom of the foot but no pain during walking, running, or eversion/inversion.
Should I go the conservative route and try PRP? Or should I get the surgery now if the torn ATFL will give me problems later on in life if I don’t repair it now?
If anyone has experience on peroneal tendon issues or Brostrom or trying PRP instead of the surgical route I would really appreciate learning about your experience!
If anyone knows how to read MRIs or ultrasounds do you see any damage in these images?
**MRI **image - Report says I have tenosynovitis but the doctor says there is a tear https://imgur.com/YhjN7Lp
Ultrasounds - radiologist says in the report that the peroneal tendons look normal with no tendinosis or tearing but my PT said they looked like a tear in these images https://imgur.com/6o8zHYZ https://imgur.com/ze1VIfw
Torn ATFL - from an ankle fracture 10 years ago but I have not had any balance or stability problems since then - result says I have scar tissue remodeling https://imgur.com/OyycrWP
Do not get surgery if you have no pain or instability. MRI results can be notoriously interpretive.
Get proper orthotics and continue your core training.
I didn’t think surgery was necessary either when there is basically no pain. I think I will go with a PRP injection since the MRI does show that the peroneal tendons are thickened.
Do you know if ultrasound images are more accurate than the MRI to show tendon issues on the ankle?
If there are no symptoms don’t treat the image, either MRI or US.
The only symptoms I have is some stiffness where the peroneal tendons run along the bottom of the foot. The tendon is also a bit thickened since I can see it snap over more when I rotate my ankle and hear the click
I’ve been afraid to push it too hard but I can walk as long as I want or do the elliptical or biking all without pain.
I think I’ll try the 1m walk 1m run like I’ve done before when coming back from an injury. I’m scared to make it worse because unlike my previous injuries I really don’t feel pain so it’s hard to know if I’m pushing too hard.
I do these procedures all the time - have a Brostrom (with Arthrex internal brace - the more modern approach) tomorrow in fact. Peroneal tendon tears (usually brevis) show often on imaging and do NOT need repaired if asymptomatic. Also, you would definitely know if you have lateral ankle instability and need that addressed. Without examining you, your plan seems pretty aggressive based on your posts - since you asked on an internet forum. At least I didn’t stay at a Holiday Inn last night …
Had a partial peroneal brevis tear 5 year ago. Funny, I could run on the treadmill but afterwards and the day(s) after it hurt walking. Had professional treatment: x-ray and steroid pack, cortisol injection which helped for a few days, finally a MRI which revealed a partial tear. Went into a walking boot for like 6 weeks with gradual removal. Swam all I wanted during the process. Resumed biking abound 14 weeks after the diagnosis. Resume easy treadmill running (walk-jog routine) 5 weeks after that. No chronic problems, no issues since. Good luck.
I do these procedures all the time - have a Brostrom (with Arthrex internal brace - the more modern approach) tomorrow in fact. Peroneal tendon tears (usually brevis) show often on imaging and do NOT need repaired if asymptomatic. Also, you would definitely know if you have lateral ankle instability and need that addressed. Without examining you, your plan seems pretty aggressive based on your posts - since you asked on an internet forum. At least I didn’t stay at a Holiday Inn last night …
Best of luck to you
The doctor performed the talar tilt test by bending by foot inwards to show that my ATFL is torn but when I’m standing, walking, running, or balancing I don’t have any instability and the strength seems similar to my right side.
If there is a tear on the tendon and it doesn’t get repaired is there a chance it would get worse and continue to split until the tendon ruptures?
And if you have experience with peroneal tendon surgery do tears that show up on MRIs usually appear worse than they were on the images?
Had a partial peroneal brevis tear 5 year ago. Funny, I could run on the treadmill but afterwards and the day(s) after it hurt walking. Had professional treatment: x-ray and steroid pack, cortisol injection which helped for a few days, finally a MRI which revealed a partial tear. Went into a walking boot for like 6 weeks with gradual removal. Swam all I wanted during the process. Resumed biking abound 14 weeks after the diagnosis. Resume easy treadmill running (walk-jog routine) 5 weeks after that. No chronic problems, no issues since. Good luck.
Wow that’s great you were able to get if fixed up without surgery or anything too invasive! Do you know if you tendon was thickened in addition to the tear? And in addition to the pain in the beginning did you have any feeling of stiffness on your foot or clicking of the tendons?
I do these procedures all the time - have a Brostrom (with Arthrex internal brace - the more modern approach) tomorrow in fact. Peroneal tendon tears (usually brevis) show often on imaging and do NOT need repaired if asymptomatic. Also, you would definitely know if you have lateral ankle instability and need that addressed. Without examining you, your plan seems pretty aggressive based on your posts - since you asked on an internet forum. At least I didn’t stay at a Holiday Inn last night …
Best of luck to you
The doctor performed the talar tilt test by bending by foot inwards to show that my ATFL is torn but when I’m standing, walking, running, or balancing I don’t have any instability and the strength seems similar to my right side.
If there is a tear on the tendon and it doesn’t get repaired is there a chance it would get worse and continue to split until the tendon ruptures?
And if you have experience with peroneal tendon surgery do tears that show up on MRIs usually appear worse than they were on the images?
Your “positive” talar tilt test can simply be some general ligamentous laxity, especially if similar to your other side. This is not unusual in women, especially with a high arch foot.
Sure, there is always a chance the longitudinal tear can progress, though complete rupture of the peroneus brevis (in the absence of acute trauma) is rare
As for MRI compared to what I find in surgery - I only use a couple of musculoskeletal radiologists that I trust and they are usually spot on. I have had intra-op findings that were worse then an MRI suggested in the past.
Your “positive” talar tilt test can simply be some general ligamentous laxity, especially if similar to your other side. This is not unusual in women, especially with a high arch foot.
Sure, there is always a chance the longitudinal tear can progress, though complete rupture of the peroneus brevis (in the absence of acute trauma) is rare
As for MRI compared to what I find in surgery - I only use a couple of musculoskeletal radiologists that I trust and they are usually spot on. I have had intra-op findings that were worse then an MRI suggested in the past.
If that’s the case I definitely don’t think I need a Brostrom repair. On my ultrasound report it said I had a history of chronic ankle sprains when I do not so that is probably why my surgeon told me I should repair the ligament. I also was really confused because the radiologist said I only had tenosynovitis of the peroneal tendons but the surgeon said she saw a tear. I guess ultrasounds might depend on the technician because my PT has one at the office and diagnosed me with a tear but at the other facility I had it done I was told there was no tearing at all.
Even though most MRIs are probably pretty accurate have there also been surgeries where the tear or problem that showed on on the MRI was not actually as bad?
If it’s not going to get any worse I think I will hold off on surgery and try to see if it gets better with rest and ankle rehab exercises.
Rroof, looks like you have tons of experience with peroneals. I had MRI which indicated large grade peroneal longus year with no full thickness. I am not sure how big the tear is and my ortho didn’t mention the size. He suggested PRP. From your experience, can it help? What are chances it will heal without surgery?
I had small tear in breviary last year which I got repaired (had scar tissue issues after) and now after having pretty great season (2HIMs, 2 fulls) I am back to square 1. I don’t have pain when walking, just nagging around where brevis was repaired. Definitely don’t want to have another surgery
Too many variables to make any sort of recommendations. But you obviously have some experience here.
In general:
Peroneal tendon pathology (tendonitis, tendinosis, small tears, etc.) is common in this groupo
Peroneal tendon pathology heals VERY slowly (hard for this group to grasp)
Reserve surgery for longer (obviously complete) tear that are SYMPTOMATIC
No harm in PRP injection. A bit overused for all sorts of things a few years back, but for most peroneal tendon pathology this makes more sense (especially if your insurance covers it).
As for my experience if a high grade tear (full thickness and over 2.5 cm +) will heal without surgery? I always defer to the larger studies regarding this as surgeons all have anecdotes both ways, but the plural of anecdotes does not equal data … and they say no.
Rroof, Thank you for getting back to me!!!
Unfortunately I am way too familiar with Peroneal Tendon issues. In 2017 after fighting tendinitis for 4 months and 3 cortisone injection (which probably weakened brevis) I was defeated and agreed for surgery. Now looking back I think it would have healed if I gave it time because tear was 2 mm! So tiny. Surgery gave me scar tissue. Still have it … I didn’t do enough strengthening of ankle after which I think is the reason for longus tear.
When I saw my ortho he wasn’t even talking about surgery at this point (he also knows I don’t want it) but when I looked at MRI report later I freaked out because everything I found is saying surgery is pretty much the only solution. I know MRI can be misleading but still…
My doc didn’t put me in boot which was surprising. Said I can bike/swim even with stupid nagging that comes and go. Plus PT. That is my protocol until PRP in 4 weeks.
He said I can run on flat surface but I am not doing that.
Here is what MRI said btw- large partial high grade peroneal longus tear. Lateral and inferior to calcaneal cuboid joint extending proximitly to posterior lateral malleolus. No full thinkness peroneal longus tear.
Not sure if it gives an idea on size? What do you think? Less than 2,5?
And yes, triathletes are crazy! And our pain tolerance is pretty crazy too!
I’m pretty confident that a proper loading protocol, which takes compressive load into consideration, will have as good results as surgery for you right now. Since I switched jobs and now have access to a diagnostic ultrasound it’s obvious that a lot of people have tears in their tendons and yet full function. It’s the degenerative parts of a tendon that tears, and the degenerative parts could not take any load anyway due to the disorganized matrix. There is a saying amongst tendon-specialist physios: focus on the doughnut, not the hole!
Rroof: there is damage to injecting with PRP. It kills tenocytes.
