Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle, Howell & Bloomfield Hills, MI
Last reviewed: May 2026
Peroneal tendon tears occur with the same ankle inversion mechanism as sprains — but the specific MRI finding that distinguishes a tendon tear from a simple ligament sprain completely changes the treatment plan. Call (810) 206-1402 — Balance Foot & Ankle serves Farmington Hills and all of Southeast Michigan.
Medically Reviewed by: Dr. Tom Biernacki DPM · Board-Certified Podiatrist · Balance Foot & Ankle PLLC · Updated 2026
Peroneal Tendon Injury Near Farmington Hills, MI
Peroneal tendon injury evaluation and treatment near Farmington Hills, MI is available at Balance Foot & Ankle in Bloomfield Hills. Dr. Biernacki DPM differentiates peroneal tendinopathy, longitudinal split tears, and subluxation with MRI, identifies the high-arch cavus foot as a major risk factor, and guides treatment from bracing and rehabilitation to surgical repair when tendons snap over the fibula. Call (810) 206-1402.
Outer Ankle Pain That Gets Worse With Activity: The Peroneal Tendons
The peroneal tendons — peroneus longus and peroneus brevis — run together behind the lateral malleolus in a fibro-osseous groove, held in place by the superior peroneal retinaculum. They are the primary evertors of the foot and ankle stabilizers against inversion injury. Peroneal tendon pathology is the most commonly under-diagnosed cause of chronic lateral ankle pain — often labeled as a persistent ankle sprain — in our Farmington Hills-area practice. There are three distinct peroneal tendon conditions with different presentations, imaging findings, and treatments. Peroneal tendinopathy: Degenerative thickening and pain of the tendon without structural tear — most common, similar to Achilles tendinopathy. Presents as lateral ankle/hindfoot aching pain with activity, tender to palpation along the tendon posterior to the fibula. Peroneal longitudinal split tear: The peroneus brevis is most vulnerable, becoming split longitudinally as it wraps around the fibula. MRI confirms the tear. Chronic lateral ankle pain and instability. Peroneal subluxation/dislocation: The tendons snap over or dislocate anterior to the lateral malleolus — often after a forced dorsiflexion/eversion injury that tears the superior peroneal retinaculum. The patient reports a “snapping” sensation at the lateral ankle. The critical risk factor: high-arch (cavus) foot — the hindfoot varus alignment of a cavus foot increases lateral loading and peroneal stress, predisposing to all three types of peroneal pathology.
Key Takeaway: Three entities: tendinopathy (treat conservatively), longitudinal split tear (surgical repair if conservative fails), subluxation/dislocation (often requires surgical retinaculum repair). MRI distinguishes all three. High-arch cavus foot = major risk factor — address underlying alignment. “Persistent ankle sprain” that isn’t improving = get MRI of the peroneal tendons. Snapping sensation at outer ankle = subluxation until proven otherwise.
Treatment by Diagnosis
Peroneal tendinopathy: Eccentric strengthening program (peroneal strengthening with resistance band), custom orthotics with lateral forefoot posting for cavus foot, immobilization boot for acute flares, physical therapy. PRP injection as adjunct for chronic tendinopathy. Avoid direct corticosteroid injection into the peroneal tendon substance — tendon rupture risk. Longitudinal split tear: Conservative first (boot immobilization 6-8 weeks, rehabilitation). Surgical repair for persistent symptoms: debridement of degenerated tissue + side-to-side repair of the split. Peroneus brevis tears with >50% of tendon cross-section lost: peroneus longus to brevis tenodesis. Peroneal subluxation: Acute (within 2 weeks): boot immobilization may allow retinaculum healing in competitive athletes (high re-dislocation rate). Chronic: surgical repair of the superior peroneal retinaculum ± deepening of the fibular groove (groove deepening procedure). Return to sport: 3-4 months after surgical repair. Cavus foot correction: Calcaneal osteotomy for severe hindfoot varus significantly reduces peroneal tendon stress and is combined with peroneal repair when appropriate.
⚠️ See a Podiatrist If:
- Lateral ankle pain persisting more than 6 weeks after an ankle sprain — peroneal tendon tear
- Snapping or popping sensation at the outer ankle — peroneal subluxation/dislocation
- High-arch foot with recurrent lateral ankle sprains — cavus alignment driving peroneal stress
- Outer ankle swelling along the tendon (not the joint line) — tendinopathy or tear
- Weakness with foot eversion (turning foot outward) — peroneal tendon disruption
OrthoInfo – AAOS: Peroneal Tendon Injuries
Getting to Our Office From Farmington Hills
Our Bloomfield Hills office at 43494 Woodward Ave #208 is about 15–20 minutes from Farmington Hills via I-696 E to Woodward Ave. We accept most major insurance. Call (810) 206-1402 or book online.
Outer Ankle Pain Not Resolving? Get a Peroneal Tendon Evaluation
Balance Foot & Ankle · Serving Farmington Hills & Michigan
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📋 Dr. Tom Biernacki, DPM, FACFAS answers:
Peroneal tendon injuries near Farmington Hills — including tendinitis, longitudinal splits, and subluxation — are treated based on severity. Conservative care includes rest, ice, NSAIDs, ankle bracing to limit inversion stress, and custom orthotics with a lateral heel post to unload the peroneals. Physical therapy rebuilding proprioception and lateral ankle strength is essential for full recovery. A walking boot is used for 4-6 weeks in moderate cases. Ultrasound-guided PRP or corticosteroid injection accelerates tendon healing. Surgical repair is needed for complete tears, chronic subluxation, or failed conservative care. Our podiatry clinic serving Farmington Hills provides same-week evaluation and ultrasound imaging.
Dr. Tom Biernacki, DPM is a board-certified foot & ankle surgeon (ABFAS & ABPM) at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has made him one of the most-followed foot & ankle educators on YouTube.