When should I see a podiatrist?

You should see a podiatrist for any persistent foot or ankle pain lasting more than a few days, difficulty walking, numbness or tingling, wounds that won't heal, changes in skin color or temperature, or structural deformities. Dr. Tom Biernacki, DPM is a board-certified podiatrist serving SE Michigan with same-day appointments available. Call 810-206-1402.

Does Dr. Biernacki accept insurance?

Balance Foot & Ankle accepts most major insurance plans including Blue Cross Blue Shield, Aetna, United Healthcare, Cigna, Medicare, and many others. Contact our office at 810-206-1402 to verify your specific coverage. We also offer affordable self-pay options.

What should I expect at my first podiatry appointment?

Your first visit includes a comprehensive evaluation with Dr. Biernacki including medical history review, physical examination, biomechanical assessment, and any necessary diagnostic imaging (X-rays are available in-office). You'll receive a diagnosis, treatment plan, and same-day treatment when possible. Most initial visits take approximately 30-45 minutes.

Medically Reviewed by Dr. Jeffery Agnoli, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists, Michigan. Last updated April 2026.

Peroneal Tendon Tears & Subluxation: The Often-Missed Ankle Injury

Name: Peroneal Tendon Tear & Subluxation Guide | Podiatrist
Creator: Dr. Tom Biernacki, DPM
Published: 2026-03-23T08:17:01-04:00

Peroneal tendon injuries are among the most commonly misdiagnosed conditions at the ankle. Patients with lateral ankle pain that doesn’t respond to “ankle sprain” treatment often have peroneal pathology. At Balance Foot & Ankle, we evaluate the peroneal tendons in every patient with chronic lateral ankle pain.

Anatomy: The Peroneal Tendons

Two peroneal tendons run behind the lateral malleolus (outer ankle bone), held in position by the superior peroneal retinaculum:

Peroneus longus: Runs under the foot to insert on the 1st metatarsal base and medial cuneiform; depresses the first ray and assists eversion
Peroneus brevis: Inserts on the 5th metatarsal base; primary evertor of the foot; first-line dynamic stabilizer against ankle inversion

These tendons are critical for lateral ankle stability and propulsion during gait.

Types of Peroneal Tendon Injuries

Peroneal Tendon Tears

Longitudinal tears (splits) are the most common type. Peroneus brevis tears occur at the fibular groove, often with a characteristic “C-shaped” split. Peroneus longus tears more commonly occur at the cuboid tunnel or at the os peroneum (a sesamoid bone in some individuals).

Tears may be acute (from a traumatic inversion injury) or chronic (from repetitive microtrauma, especially in high-arched feet).

Peroneal Tendon Subluxation/Dislocation

The superior peroneal retinaculum holds the tendons in their groove behind the fibula. When this retinaculum tears (usually from sudden forced dorsiflexion and eversion — common in skiing and basketball), the peroneal tendons can snap out of the groove. Patients feel and sometimes hear a “pop” at the time of injury; chronic cases describe a snapping sensation with ankle movement. This is commonly misdiagnosed as a lateral ankle sprain.

Peroneal Tendinopathy

Tendinosis (degeneration) without complete tear; causes chronic lateral ankle and hindfoot pain with activity.

Symptoms

Lateral ankle and hindfoot pain, particularly posterior to the fibula
Pain with ankle eversion (pushing the foot outward) against resistance
Snapping or popping of tendons over the fibula (subluxation)
Swelling behind the lateral malleolus
History of ankle sprain that didn’t fully recover
High-arched (cavus) foot — a significant risk factor for peroneal pathology

Diagnosis

Clinical examination: Peroneal strength testing, resisted eversion, palpation behind the fibula, active subluxation provocation test
Ultrasound: Dynamic imaging — can show tendon subluxation in real time with provocative maneuvers; excellent for tendon tears
MRI: Best for complete characterization of tears, SPR integrity, and surgical planning
X-ray: A rim fracture of the fibula (avulsion of SPR attachment) is pathognomonic for acute subluxation; foot alignment assessment

Treatment

Conservative (Non-Surgical)

Walking boot immobilization for 4–6 weeks (acute tears and subluxation)
Custom orthotics: lateral wedging and ankle bracing for chronic tendinopathy; valgus heel wedge for cavus foot
Physical therapy: peroneal strengthening, proprioception training
PRP injection: for chronic tendinopathy that hasn’t responded to conservative measures

Surgical Treatment

Surgery is indicated for: large tendon tears (>50% thickness), failed conservative care, acute subluxation/dislocation in an athlete, or chronic recurrent subluxation. Procedures include:

Peroneal tendon repair: debridement of degenerate tissue; side-to-side repair for longitudinal tears
Superior peroneal retinaculum reconstruction: tighten or reconstruct the retinaculum to prevent subluxation
Fibular groove deepening: when the groove is shallow, deepening it prevents future subluxation
Calcaneal osteotomy: for cavus foot deformity driving the pathology

Recovery: 6–8 weeks non-weight-bearing, then gradual rehabilitation over 3–4 months.

Ready to Get Relief? We’re Here to Help.

Board-certified podiatrists Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients daily at our Howell and Bloomfield Township, MI offices.

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Dr. Tom Biernacki, DPM

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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.