Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.
Medically reviewed by Dr. Jeffery Agnoli, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle
Last reviewed: April 4, 2026
QUICK ANSWER
Peroneal tendon tears and subluxation cause lateral ankle pain, instability, and snapping behind the fibula. Surgery repairs torn tendons and deepens the peroneal groove to prevent recurrence. Most patients return to activity at 4-6 months with excellent outcomes.
The Peroneal Tendons and Why They Matter
The peroneal tendons are two tendons — peroneus brevis and peroneus longus — that course behind the lateral malleolus (the outer ankle bone) and attach to the fifth metatarsal base and the medial cuneiform respectively. These tendons are the primary evertors of the foot and provide critical lateral stability to the ankle. When the peroneal tendons are torn, frayed, or dislocate out of their groove behind the lateral malleolus, they become a source of lateral ankle pain that can significantly limit activity.
At Balance Foot and Ankle, our foot and ankle surgeons treat peroneal tendon pathology in athletes and active patients throughout Southeast Michigan, providing both conservative management and surgical repair when indicated.
Peroneal Tendon Tears
Peroneus brevis tears are the most common peroneal tendon injury. The tendon typically splits longitudinally — producing a split tear that appears as a C-shaped or inverted C-shaped configuration on MRI — at the level of the posterior fibular groove where it wraps around the back of the ankle. The tear is often associated with ankle instability, as a lax superior peroneal retinaculum allows the tendons to shift abnormally and abrade against the fibula. Peroneus longus tears more commonly occur at the cuboid notch where the tendon turns to cross the plantar foot.
Symptoms include lateral ankle and hindfoot pain with activities requiring ankle dorsiflexion and eversion, tenderness directly behind the lateral malleolus, and sometimes a palpable click or pop with ankle motion. MRI is the definitive imaging study for evaluating tear extent and determining surgical planning.
Peroneal Tendon Subluxation
The superior peroneal retinaculum is the ligamentous band that holds the peroneal tendons in their fibular groove. Acute ankle sprains can tear or avulse this retinaculum, allowing one or both tendons to snap forward over the lateral malleolus — a condition called peroneal subluxation. Patients describe a painful snapping on the outer ankle with certain movements. Left untreated, chronic subluxation leads to progressive tendon fraying and eventual tearing.
When Surgery Is Indicated
Conservative management including immobilization, physical therapy, and bracing is appropriate for minor partial tears and acute subluxation injuries. Surgical treatment is indicated for complete tears, significant longitudinal splits not responding to conservative care, and recurrent peroneal subluxation. The goal of surgery is to restore tendon integrity, eliminate subluxation, and correct any contributing factors such as a shallow fibular groove or concurrent ankle instability.
The Surgical Procedure
Peroneal tendon surgery is performed through an incision posterior to the lateral malleolus. The retinaculum is opened, and the tendons are inspected. Longitudinal tears are repaired with tubularization sutures that close the split and restore a round tendon cross-section. Severely damaged tendon segments may require excision and tenodesis of the remaining healthy tendon. The fibular groove is deepened if shallow. The superior peroneal retinaculum is repaired or reconstructed to prevent subluxation recurrence.
Recovery After Peroneal Tendon Surgery
A short leg cast or CAM boot protects the repair for 4 to 6 weeks. Progressive weight bearing begins at 2 weeks for simple repairs. Physical therapy focusing on peroneal strengthening, proprioception, and return-to-sport training begins at 6 to 8 weeks. Most patients return to athletic activity within 3 to 5 months. Re-tear rates are low with adequate rehabilitation.
If you have lateral ankle pain that has not responded to conservative treatment, contact Balance Foot and Ankle for evaluation. Our foot surgeons serve Southeast Michigan with same-week appointments.
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Warning
Chronic lateral ankle pain and instability after ankle sprain, especially with a snapping or popping sensation, suggests peroneal tendon pathology. Untreated tears progress and chronic subluxation causes permanent tendon damage requiring more complex surgery.
Frequently Asked Questions
How do I know if I have a peroneal tendon tear?
Symptoms include chronic lateral ankle pain behind the fibula, feeling of instability, popping/snapping sensation, and pain with resisted eversion. MRI confirms the diagnosis and distinguishes tears (longitudinal splits) from tenosynovitis.
What is the recovery time for peroneal tendon surgery?
After surgical repair, patients are non-weight bearing 2-4 weeks, then transition to a boot for 4-6 weeks, regular shoes at 8-10 weeks, and return to sports at 4-6 months. Physical therapy is essential starting at 2-4 weeks.
Can peroneal tendon tears heal without surgery?
Partial tears with minimal symptoms can be managed with immobilization in a boot for 4-6 weeks, followed by physical therapy and bracing. Surgical repair is indicated for tears >50%, failure of conservative care, recurrent subluxation, or active athletes.
Snapping or Pain Behind the Ankle?
Dr. Agnoli diagnoses peroneal tendon tears with MRI and performs repair surgery with groove deepening. Consultations at 7 Michigan locations.
Book AppointmentPeroneal Tendon Surgery at Balance Foot & Ankle
Peroneal tendon tears and subluxation can cause chronic lateral ankle pain and instability. Dr. Tom Biernacki at Balance Foot & Ankle performs peroneal tendon repair, groove deepening, and reconstruction at our Howell and Bloomfield Hills offices.
Learn About Our Tendon Surgery Options | Book Your Appointment | Call (810) 206-1402
Clinical References
- Dombek MF, et al. “Peroneal tendon tears: a retrospective review.” Journal of Foot and Ankle Surgery. 2003;42(5):250-258.
- Redfern D, Myerson M. “The management of concomitant tears of the peroneus longus and brevis tendons.” Foot and Ankle International. 2004;25(10):695-707.
- Krause JO, Brodsky JW. “Peroneus brevis tendon tears: pathophysiology, surgical reconstruction, and clinical results.” Foot and Ankle International. 1998;19(5):271-279.
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.
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)
- Hallux Valgus (Bunions): Evaluation and Management (PubMed)
- Bunions (Mayo Clinic)