Peroneal Tendinopathy

Sydney C. Karnovsky

Mark C. Drakos

Positioning

Place the patient in a supine position. Position a large bump under the hip to create a sloppy lateral-type position.
Place a nonsterile tourniquet on the operative thigh. Prep and drape the lower extremity in a sterile manner.
Exsanguinate the lower extremity and inflate the tourniquet 250 mm Hg.

Surgical Approach

Identify the fibula just posterior to bone (Figure 14-1).
Make a 6-cm incision on the lateral aspect of the patient’s fibula.

Figure 14-1. The site of the incision is identified and marked on the patient’s ankle.
Incise the peroneal retinaculum. Take care to avoid injury to the sural nerve, which is posterior to the peroneals at this level (Figures 14-2 and 14-3).
Identify the area of tendinopathy and determine whether there is any dislocation.

Figure 14-2. The peroneal retinaculum is identified.

Figure 14-3. The peroneal tendons are identified, and the retinaculum is tagged.
Determine whether there is any damage to the superior peroneal retinaculum. You should be looking for longitudinal split tears, areas of thickening and tendinopathy, low-lying peroneus brevis muscle belly, and peroneus quartus (Figures 14-4, 14-5, 14-6).
Determine whether the peroneus brevis or longus is damaged and/or torn (Figures 14-7 and 14-8).

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