Peroneal Tendon Repair Surgery: Treating Longitudinal Tears and Subluxation

Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

The Peroneal Tendons: Lateral Ankle Stabilizers

Two peroneal tendons run behind the lateral malleolus — the bony prominence on the outer ankle. The peroneus brevis attaches to the fifth metatarsal base and is the primary evertor of the foot. The peroneus longus crosses beneath the foot to attach at the medial cuneiform and first metatarsal base, helping stabilize the arch. Both tendons are held in their groove behind the lateral malleolus by the superior peroneal retinaculum (SPR). When these tendons are injured — through tears, instability, or inflammation — the result is chronic lateral ankle pain that is frequently misattributed to ankle sprain and undertreated.

Types of Peroneal Tendon Injuries

Longitudinal Tears

Peroneus brevis tears characteristically run longitudinally along the tendon — a ‘split’ tear that creates a C-shaped appearance when the tendon is viewed during surgery. These tears result from repetitive compression between the peroneus longus and the posterior fibula in the retro-malleolar groove, often in the context of chronic ankle instability. Peroneus longus tears occur less commonly and can affect any portion of the tendon including at the peroneal tubercle and the cuboid notch.

Peroneal Tendon Subluxation and Dislocation

The superior peroneal retinaculum is the primary restraint preventing the peroneal tendons from dislocating out of their groove. An acute ankle dorsiflexion injury — particularly in skiers — can avulse the SPR from the fibula, allowing the tendons to pop over the lateral malleolus. Patients feel and sometimes hear a snapping sensation on the outer ankle with certain movements. Chronic subluxation is often misdiagnosed for months or years as recurrent ankle sprains.

Diagnosis

Clinical examination reveals tenderness directly behind the lateral malleolus, pain with resisted ankle eversion, and in subluxation cases, palpable or visible tendon snapping with ankle circumduction. MRI is the gold standard for evaluating tendon integrity — longitudinal splits, tenosynovitis, and retinacular avulsion are all well-visualized. Ultrasound provides a dynamic assessment that can demonstrate subluxation in real time during provocative maneuvers.

Conservative Treatment

Acute peroneal tendon injuries with tenosynovitis respond to a period of immobilization in a boot, followed by progressive rehabilitation focused on peroneal strengthening, proprioceptive training, and gradual return to activity. Corticosteroid injection into the peroneal sheath provides anti-inflammatory relief in cases of tenosynovitis. However, longitudinal tendon tears and subluxation rarely resolve with conservative care alone and typically require surgical intervention for athletes and active patients.

Surgical Options

Tendon Debridement and Tubularization

For small peroneus brevis longitudinal tears with healthy tissue on either side, debridement of the torn edges and tubularization — closing the split tendon into a cylindrical shape — restores function without sacrificing the tendon. This is the preferred approach when enough viable tendon remains.

Tenodesis

When the peroneus brevis is severely damaged with more than 50 percent cross-sectional involvement, tenodesis — suturing the brevis to the intact peroneus longus — provides reliable pain relief and preserves eversion strength through the longus.

Superior Peroneal Retinaculum Repair

Subluxation is corrected by repairing or reconstructing the superior peroneal retinaculum. If the fibular groove is shallow, concurrent groove-deepening (fibular groove plasty) creates a more secure anatomical constraint. The SPR repair is performed with suture anchors placed into the fibula, and the retinaculum is advanced and secured in its anatomic position.

Recovery

Most peroneal tendon procedures require 2 weeks non-weight bearing followed by 4 to 6 weeks in a boot with progressive weight bearing. Physical therapy emphasizing peroneal strengthening, proprioception, and functional sport-specific training extends from 6 weeks to 3 to 4 months. Return to sport typically occurs at 4 to 6 months. Long-term outcomes for properly selected and executed peroneal tendon surgery are excellent, with the large majority of patients returning to full activity.

If you have chronic lateral ankle pain that has persisted despite treatment for ankle sprains, peroneal tendon pathology may be the underlying cause. Contact Balance Foot & Ankle for a comprehensive evaluation.

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Peroneal Tendon Surgery in Michigan

Peroneal tendon tears cause chronic lateral ankle pain and instability. Dr. Tom Biernacki performs peroneal tendon repair and reconstruction at Balance Foot & Ankle, restoring ankle stability and function.

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Clinical References

1. Raikin SM, et al. “Peroneal tendon disorders.” Clin Sports Med. 2009;28(1):105-129.
2. Dombek MF, et al. “Peroneal tendon tears: a retrospective review.” J Foot Ankle Surg. 2003;42(5):250-258.
3. Redfern D, Myerson MS. “The management of concomitant tears of the peroneus longus and brevis tendons.” Foot Ankle Int. 2004;25(3):157-163.

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Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon 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 reached over one million views.