Medically reviewed by Dr. Tom Biernacki, DPM · Board-Certified Podiatric Surgeon · Last reviewed: April 2026 · Editorial Policy
Quick Answer
Peroneal Tendon Split Tear: Surgical Repair, Tubularization, relates to tendon injury — typically caused by overuse or sudden strain. Most patients improve in 6-12 weeks with conservative care. Same-week appointments in Howell + Bloomfield Twp: (810) 206-1402.
Quick Answer
Most foot and ankle problems respond to conservative care — proper footwear, supportive inserts, activity modification, and targeted stretching — within 4-8 weeks. Persistent pain beyond that window, or any symptom that prevents walking, warrants a podiatric evaluation to rule out fracture, tendon tear, or systemic cause.
Medically Reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists, Michigan. Last updated April 2026.
Peroneal tendon split tears — longitudinal tears (rather than transverse ruptures) occurring most commonly in the peroneus brevis tendon as it courses around the fibular tip — are a frequently overlooked cause of chronic lateral ankle pain, particularly in patients with chronic ankle instability, cavus foot deformity, or a history of repetitive ankle sprains. The peroneus brevis, trapped between the posterior fibula and the peroneus longus tendon, is mechanically pinched with each inversion episode, producing the characteristic ‘C-shaped’ or ‘banana peel’ longitudinal split that can be detected with MRI or ultrasound but is frequently missed on standard imaging reports.
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Anatomy, Risk Factors, and Diagnosis
Peroneus brevis split tear anatomy: the PB tendon wraps tightly around the fibular tip in the retromalleolar groove; compression between the fibular tip (anteriorly) and the peroneus longus tendon (posteriorly) produces the characteristic longitudinal split; the typical split begins at the fibular tip level and extends proximally and distally; Grade I (partial — <50% cross-sectional area); Grade II (partial — >50%); Grade III (complete). Risk factors: chronic ankle instability (the most significant risk factor — 25–77% of CLAI patients have concurrent PB pathology); hindfoot varus (cavus foot deformity); low-lying peroneus brevis muscle belly crowding the retromalleolar groove; superior peroneal retinaculum insufficiency. MRI diagnosis: axial MRI at the fibular tip level — the PB split appears as a ‘C-shaped’ or bilobed tendon on axial slices (the split PB wraps around the cylindrical PL tendon); fluid signal within the split confirms tear. Ultrasound: dynamic examination allows assessment during ankle motion; shows the split morphology and concurrent tendon sheath fluid; operator-dependent but can be highly accurate in experienced hands.
Surgical Management
Indication: failed conservative management (physical therapy, peroneal strengthening, bracing × 3–6 months) with persistent lateral ankle pain. Exploration and debridement: through a posterolateral approach; superior peroneal retinaculum opened; both peroneal tendons fully inspected from the myotendinous junction to the cuboid; debridement of degenerative tissue and tear edges. Tubularization (for PB tears <50% cross-sectional area): side-to-side repair of the split with running absorbable suture; tubularizes the split tendon back to a cylindrical morphology; good outcomes (85%) for Grade I–II splits with viable tissue. Tenodesis (for PB tears >50% or Grade III): significant PB split with poor tissue quality — tenodesis of the distal PB stump to the PL tendon; the PL assumes the functional role; functional outcomes 80–85% with appropriate rehabilitation. Concurrent Broström: concurrent CLAI repair (Broström-Gould) performed when both instability and PB split coexist — treating both in a single surgery provides superior outcomes to staged repair. Dr. Biernacki at Balance Foot & Ankle diagnoses and surgically repairs peroneal tendon split tears at our Bloomfield Hills and Howell offices. Call (810) 206-1402.
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When to See a Podiatrist
Foot and ankle surgery in 2026 is dramatically different than a decade ago — most procedures are now minimally-invasive, outpatient, and allow weight-bearing within days. Balance Foot & Ankle surgeons have performed 3,000+ foot/ankle surgeries with modern techniques. If another surgeon has recommended a traditional open procedure, a second opinion may reveal a faster, less-invasive option.
Call Balance Foot & Ankle: (810) 206-1402 · Book online · Offices in Howell & Bloomfield Hills
Frequently Asked Questions
When should I see a podiatrist?
See a podiatrist for any foot or ankle pain that persists more than 2 weeks, doesn’t improve with rest, limits your daily activities, or is accompanied by swelling, numbness, or skin changes. People with diabetes or circulation problems should see a podiatrist regularly even without symptoms.
What does a podiatrist treat?
Podiatrists diagnose and treat all conditions of the foot, ankle, and lower leg including plantar fasciitis, bunions, hammertoes, toenail problems, heel pain, nerve pain, diabetic foot care, sports injuries, fractures, and foot deformities — both surgically and non-surgically.
What can I expect at my first podiatry visit?
Your first visit includes a full medical history, physical examination of your feet and gait, and in-office diagnostic imaging if needed (X-rays, ultrasound). We’ll discuss your diagnosis and create a personalized treatment plan. Most visits take 30–45 minutes.
Need Treatment at Balance Foot & Ankle?
Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients at our Howell and Bloomfield Township offices.
Book Online or call (810) 206-1402
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Howell Office
3980 E Grand River Ave, Suite 140
Howell, MI 48843
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Bloomfield Hills Office
43700 Woodward Ave, Suite 207
Bloomfield Hills, MI 48302
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Same-week appointments available at both locations.
Book Your AppointmentMost Common Mistake We See
The most common mistake we see is: Waiting too long before seeking care. Fix: any foot pain lasting more than 4 weeks, or any sudden severe symptom, deserves a professional evaluation rather than more rest.
Warning Signs That Need Same-Day Care
Seek immediate evaluation at Balance Foot & Ankle if you experience any of the following:
- Unable to bear weight
- Severe swelling with skin colour change
- Fever with foot pain (possible infection)
- Diabetes plus any new foot symptom
Call (810) 206-1402 — same-day and next-day appointments at our Howell and Bloomfield Hills offices.
More Peroneal Tendonitis Guides from Dr. Tom
Need treatment? Learn about in-office peroneal tendonitis treatment at Balance Foot & Ankle, or call (810) 206-1402 for same-day appointments.
