Published online Feb 18, 2020. doi: 10.5312/wjo.v11.i2.137
Peer-review started: October 13, 2019
First decision: November 1, 2019
Revised: November 21, 2019
Accepted: December 23, 2019
Article in press: December 23, 2019
Published online: February 18, 2020
Processing time: 128 Days and 11.7 Hours
Peroneal tendon disorders are common causes of lateral hindfoot pain. However, total rupture of the peroneal longus tendon is rare. Surgical treatment for this condition is usually a side-to-side tenodesis of the peroneal longus tendon to the peroneal brevis tendon. While the traditional procedure involves a long lateral curved incision, this approach is associated with damage to the lateral soft tissues (up to 24% incidence).
A 50-year-old female had developed pain at the lateral aspect of the hindfoot 1 mo after an ankle sprain while walking in the street. Previous treatments were anti-inflammatory drugs, ice, rest and Cam-walker boot. At physical exam, there was pain and swelling over the course of the peroneal tendons. Ankle instability and cavovarus foot deformity were ruled out. Eversion strength was weak (4/5). Imaging showed complete rupture of the peroneal longus tendon associated with a sharp hypertrophic peroneal tubercle. Surgical repair was indicated after failure of conservative treatment (physiotherapy, rest, analgesics, and ankle stabilizer). A less invasive approach was performed for peroneal longus tendon debridement and side-to-side tenodesis to the adjacent peroneal brevis tendon, with successful clinical and functional outcomes.
Peroneus longus tendon tenodesis can be performed through a less invasive approach with preservation of the lateral soft tissue integrity.
Core tip: Traditionally, tenodesis of the peroneus longus tendon has been performed through a long lateral curved incision on the hindfoot. However, this approach is often associated with damage of the lateral soft tissues, having an incidence that ranges from 2.4% to 54%. The highlight of this study is its presentation of a less invasive approach for side-to-side tenodesis of full-thickness rupture of the peroneus longus tendon, which preserved most of the lateral soft tissue prone to wound breakdown.