Can I Run with a Split Peroneal Tendon

[@beaware6487]

Fabulous explanation. After a previous IT band and groin strain 2 years ago I knew the mantra when I got my ankle injury 2 weeks ago from running intervals: Immediately stop running! So now it's stretch lightly and strengthen ankle drills low reps for now and monitor pain after just 1-2 km walks with extra cushioned shoes. Patience is called for.

[@m.taylor]

This is the most comprehensive informative video on this topic and the most helpful. It is true the harrowing aftermath of having worn a cast or boot and disuse of the injured leg for a while.

[@DocOnTheRun]

@@m.taylor thank you so much for watching and for adding your comments to share your experience!

[@Aviation_Professional]

So 3 weeks post Peroneal tendon resection. After consults with 3 surgeons (who only agreed on the tendon repair) and 3 differing opinions I opted to go with 3 procedures. Tendon repair, Heel Dwyer osteotomy (cavus foot) and the 1st metatarsal wedge osteotomy. The procedure lasted 4 hours here in Ft Myers. 1 week post op I was so excited to hear from the surgeon and see the imaging. Surgeon walked in with a stoic face and said there was a problem. Actually 2 problems. The heel osteotomy had 1 protruding screw head that you can palpate and the heel slide was not level. It was about 6-8mm elevated from the plantar surface bone creating a ridge of bone that I will be stepping on once weight bearing. To his credit he did own the errors but that simply infuriates me as he is not the one that will have to deal with 1/2 more procedures because of his errors. He even did this under fluoroscopy which makes this more puzzling. He gave me the option to redo the heel osteotomy and I chose to not allow him to ever touch my foot again. Choose your surgeon wisely folks.. It really does matter!!

[@DocOnTheRun]

Thank you for sharing your story Anthony. I am sure your experience can help others. Wishing you a speedy recovery.

[@shivanibhardwaj8970]

He explained it really well....some really good information for all the medicos and even for layman he expand in some really easy way to understand.

[@DocOnTheRun]

Glad it was helpful!

[@jgr8210]

Thanks for your informative video on the Split Peroneal Tendon. I now have a better understanding of the pros and cons of treatment. Cheers

[@DocOnTheRun]

Hi JRG, Thanks for watching and commenting. Glad you found the video helpful.

[@tjgauthier9252]

Great overview of this subject. I know how difficult it is to speak on camera like you do.

[@DocOnTheRun]

Thank you so much! Truly appreciate it.

[@borisk597]

Thank god it's the 21st century and people have access to such high-quality information on youtube! Thank you for the very informative video. I had moderate swellings and pains in the foot for a couple of months and found a peroneus brevis split according to MRI, so the doctor suggested shockwave therapy in combination with a boot. I am going to try this anyway, but it would be nice if you could comment whether shockwave is helpful for such cases from your point of view? Thanks!

[@DocOnTheRun]

@@borisk597 thank you for watching and I hope you found the video helpful! I'm sorry to hear about your peroneal tendons. If you would like to discuss what options might be best given the results of your MRI we could get on a webcam call or a phone call to discuss in detail.

[@Lily-b7s9p]

Hi Christopher, thanks for all your video’s, they’re absolutely brilliant! I’m a physio in the UK and my husband is a keen ultra runner. He’s just found out he has a 2.3cm split tear of the peroneus brevis, diagnosed via ultrasound, which is behind the lateral malleolus. There is also an associated lump in this region which was what led him to seek further imaging / medical attention. He’s been advised by a surgeon to continue with Physiotherapy, which he has been doing for the last 9 months. The information that you have provided about a peroneus brevis tear in this specific location makes complete sense, and we’ve spent many hours trying to find further information / evidence around the likeliness of a tear of this nature healing with time / patience / optimal loading and I wondered if there are any current studies / evidence that you may be able to point us in the direction of?

[@rowright3238]

Thank you for this information. I felt a rip in ankle a few years ago-didn't cause me much trouble, so never had it checked. I also had a mass which was growing and the MRI showed the longitudinal tear of the Peroneal Brevis. I recently had surgery and am in a boot. This has been more painful that the problem-so I wondered if I did the right thing. You convinced me it was the best decision for me--I ran years ago-but not in a long time and recently retired-so would like to eventually restart. Your video was very focused and provided the information I needed.

[@DocOnTheRun]

Hi Ro, Thanks for watching and for your comments. So glad you found the video helpful. Heal fast!

[@kennethshort2016]

I'm not a runner but developed the kind of ankle pain you describe. Tests show a peroneal split tear. Doctor highly recommended surgery but I will now get a couple more opinions. He did say that MRIs can be tricky.

[@DocOnTheRun]

Sorry to hear about your tendon, but thank you for sharing your experience. It is never too late to get another opinion!

[@Aviation_Professional]

Fabulous presentation.

[@DocOnTheRun]

Thank you kindly!

[@madridjammeh4539]

I mean the address tendons injury

[@madridjammeh4539]

I got tendons injury

[@oskarm1034]

This is the worst injury I have ever had. Broken bones don't compare when you are an active person. I split my peroneal and brevis tendon almost 3 years ago and walked for 2 months till it was unbearable. Got surgery and recovered pretty fast in 6 months with physiotherapy but it split again just by walking on uneven surfaces during winter. My option now after 3 years is getting surgery again. But it is highly unlikely that it will hold because it was in very bad shape before surgery. If this surgery does not work he told me he could remove the peroneal tendon completely. I think that is not a better option. Can the Doc On The Run give me an opinion?

[@VJ-td6oc]

I watched the video. I didn't hear you mention the upper split of peroneus longus(outside of the calf muscle,just bellow the knee). I got my injury 4 weeks ago,when I tried to run barefoot on a threadmill. It doesn't hurt when i move the leg in any direction,I can do squats,deadlifts and calf raises with no pain but I can't run. The pain appears only when I try to run even for 15minutes slowly,and it lasts for a day and goes away.

[@ktaylor9804]

Thank you for the detailed explanation!! I'm recovering from a split tear brevis and reconstruction of anterior tibialis tendons surgery. I haven't been able to gleen info from P Therapy re: rehab exercises to strengthen my ankle.

[@markmurray6039]

I am a 60 yr old runner (50-60 mi/wk). MRI last week confirmed a longitudinal tear of peroneus brevis. The tear likely occurred rolling my ankle on a trail run 9 months ago. While the injury caused me to miss a few days here and there, I've continued to run and race. The injury has undermined my running mechanics, and I can't access top end speed. However it doesn't appear to have a significant impact on Marathon pace (6:30-40) or slower. So tomorrow I will be running a marathon. Monday I meet with orthopedic Dr to discuss how to proceed. I would like to be able to schedule a 2nd opinion and provide you access to MRI.

[@DocOnTheRun]

Good luck in your marathon today!

[@DocOnTheRun]

After the dust settles, you can schedule a Running Injury Second Opinion Consultation over Webcam (with MRI review) here: www.docontherun.com/payment-running-injury-second-opinion-skype-consultation-call-60-minutes/ PLEASE NOTE: my web cam consult schedule is very full and quickly approaching zero availability, so please block my calendar as soon as possible.

[@markmurray6039]

Thanks Doc. I had no difficulty completing the marathon taking a conservative, negative split approach (1:29:30; 2:57:45). The next day, reviewing the MRI with my ortho, he showed/described the 'tear' as seemingly minor, and. Importantly, located below where the tendon turns around (under?) Fibula. He did not perceive I was candidate for treat beyond PT, and we discussed strategies to prevent/reduce future ankle rolls. So undertaking strength/stabilization routine with PT.

[@ukguy]

I have this but because of cavo varus foot my surgeon wants to do calcaneal osteotomy and tendon transfers. I'm concerned the surgery might actually make it worse or I will be unable to run again after.

[@someone-ji2zb]

What if no split, but there is peroneal subluxation behind the socket? Been about a year since my injury, and did about 4 months of physical therapy after the first 2 months of being on crutches. MRI from 2 months after the injury, showed slight tear on the peroneal tendon and some ligament damage; they said it was peroneal tendonitis. Anyway, I kept trying to do basic exercises I learned at physical therapy once my sessions ended, and for the last 3 months or so I have been trying to walk at least an hour a day (with some days being rest days depending on feel). Well the issue is that even a slight elevation change is causing the tendon to slip over the bone and back, and while the first few times have no pain associated with it, eventually the 4th comes (funny enough it is always on #4) and then there is pain and I stop whatever I am doing. There is no bruising or inflammation involved, but there is slight soreness along the middle peroneal tendon where it wraps around and behind that socket bone. Seems like while I have regained my strength and then some in regards to my calves and most of my foot muscles (a lot of towel grabbing, calf raises, heel raises, balance board usage, one leg balancing, using bands to provide resistance while moving my foot in 3 different directions), the tendon seems to be going no where in regards to that slipping. This slipping does not get in the way with static exercises in weight lifting (squats and deadlifts there is 0 pain and no slip), and even walking on a flat surface is fine, but the moment the surface is no longer flat for a moment or I attempt to jog (even on a flat surface) the tendon wants to slip back and forth.

[@jonmccoy87]

If you superior peroneal retinaculum is subluxing over you malleolus, you might have torn your retinaculum. It's a tendon the prohibits the spr from subluxation.

[@DocOnTheRun]

If you want specific to your exact situation, and prefer to meet and discuss with me personally, we could get on a webcam call or phone call today or tomorrow to help you figure out what you should be doing. If so, you can pick a time that works for you and block my calendar for a private call here: www.docontherun.com/talk-to-the-expert/

[@m.taylor]

It's been a while so I don't know if you have corrected this, but something to consider is wearing an fabric ankle brace that can be worn inside shoes for times when you go jogging to prevent the peroneal subluxation.

[@antd2733]

What about a partial split tear of the brevis

[@DocOnTheRun]

Thank you for watching. I am sorry, but I do not understand your question.

[@antd2733]

@@DocOnTheRun my mri says I have a “Partial longitudinal split tear of the peroneus brevis in the inframalleolar location with reconstitution distally beyond the peroneal tubercle. Mild peroneus longus tendinosis. Associated tenosynovitis of the peroneal tendons. Anterior extensor compartment tendons are intact.” Do I need surgery?

[@antd2733]

@@DocOnTheRun thank you for replying I’m in a lot of pain and my general ortho says a partial tear is nothing. He initially didn’t even read the mri and told me mri came back good. Then I told him it says I have tear and he says it’s nothing very small. I’m in pain when I walk and it feels like it’s getting worse.

[@DocOnTheRun]

That sounds incredibly frustrating!~ I always review the entire MRI with the runner, even when done over webcam via screen share. I think it is vitally important that any injured runner actually see what the doctor perceives when reading the MRI. Seeing the images yourself may be helpful during a second opinion. @@antd2733

[@SunshineAndSails]

Soo resting causes permanent atrophy? Seems overly pessimistic.

[@DocOnTheRun]

Thank you for watching. I agree with you that it would be overly pessimistic to state that resting causes permanent atrophy. However, that is not what I said.

[@katykelly3912]

Thank you for the informed presentation. For a split peroneal brevis tendon near the fibula and requires surgery- how approximately how long is the recovery for that type of surgery? I have the split brevis and I am hoping to compete in the Boston Marathon April 2023.

[@DocOnTheRun]

Hello Katy, Thanks for watching and posting your comments! I am sorry to hear your peroneal tendon injury is interfering with running...and potentially killing your chances of running Boston. Unfortunately, (based only on the information you provided) I cannot tell you how long your recovery for surgery, because I have not assessed the severity of your injury, your overall health status, response to treatments thus far, nor the surgical technique your surgeon plans to use and/or the adjunctive therapies you intent to add to accelerate healing after your surgery. Without having a detailed discussion, I could not offer any medical advice or speculate on whether or not you would even be able to run Boston i you have surgery. I would be happy to help and provide a second opinion, but at present my schedule is very booked due to high demand. If you would like to discuss your situation in detail, you can block my calendar for a webcam call here: www.docontherun.com/talk-to-the-expert/

[@vph1004]

I had an MRI this week and it confirmed a partial longitudinal split of the Peroneus Brevis tendon in the distal side of lateral malleoli. Apparently there was no dislocation or subluxation. My ortho seemed very casual about it and just told me to avoid exercise that puts great pressure to the ankle. But shouldn't this type of an injury require a surgery? I had a fibula fracture back in July which was not operated but treated conservatively.

[@christianallison993]

Did conservative treatment of the split heal the tendon?

[@Dumdidei94]

What have you done? Going surgery? was conservative treatment succesfull?

[@LEDOmar23]

Was diagnosed with a partial tear in the peroneal tendon. How is that different? I’ve recently been diagnosed. Been walking on it for two years with some pain and every so often some very good days. Never could run however. When I finally decided to seek a second opinion I had an mri done. Since then I feel like my foot has grown worse in the boot (so it feels). Essentially I feel like there is no hope and that I’ll never run and that I’ll require surgery.

[@rdranki1]

Did you get better

[@LEDOmar23]

Roman Drankin yeah actually. I went to PT (different from the first place) and she worked with me extensively and helped me strengthen my foot/ankle/knees/hips and lower back and it’s been huge relief.

[@rdranki1]

@@LEDOmar23 what pt place was it? What did doctor at your second opinion said? Doctor told me that my mri showed bursitis but i know i also got peroneal tendonitis. Did you suffer any nerve damage? I have tingling on top of my foot to the left of my outside ankle bone. Its just tingling

[@LEDOmar23]

Roman Drankin it’s a Baylor rehab PT. The second doctor had me in a boot for 3 months before I switched over to a orthopedic brace for 7 months about and towards the end of the 7 month he referred me out to a surgeon who said i should do PT and see how things work. I had pain at the arch of my foot and outside the left ankle. Had some mild numbness from my left toe region towards the middle of my top foot. My therapist worked me towards the treadmill slowly and used dry needling as well for my arch pain which was very therapeutic. My foot feels close to normal before the injury now.

[@Dumdidei94]

what kind of strengthening exercises do you have done? i have a peroneal brevis tendon split behind the fibula and pain for about 6 month...

[@cengizarici]

Can my doctor tell me if I need a surgery by looking at my ankle? MRI tells me I have a split tear. I was on a cast for Achilles injury, but not sure if my other tears can be fixed

[@DocOnTheRun]

Thank you for wathcing. I have no idea who your doctor is, nor whether or not she has the diagnostic acumen to tell.

[@tedjohnson64]

This is the first I've heard that a cast and crutches can cause *permanent* atrophy and stiffness. Yikes.

[@djbarela4]

What if I have a split tear in my peroneus brevis tendon my Dr didn’t recommend surgery and said I can get back to sports ?

[@Guizaguiza]

Thoughts on longitudinal split tear of the peroneus brevis tendon at the level of the lateral malleolus on a background of mild tendinosis of the peroneus brevis and longus tendons and with minimal associated tenosynovitis? Been 2 months since initial injury. Been on crutches for last month. Ortho and podiatrist recommended physical therapy and that I get off crutches. Can you explain why getting off crutches if there’s pain makes sense? Also for the record I’m not trying to run on it or exercise at all. Just want to get better. Thank you 🙏

[@matiasortizxxi]

How did you get? I have the same injury.

[@sanjaphiartist]

I have the same injury, on both feet

[@DocOnTheRun]

Thank you for watching and sharing all the detail. Unfortunately though I cannot make any recommendation or comment specifically on your condition because I don’t know enough about you or the specifics of the injury.

[@Guizaguiza]

@@DocOnTheRun not sure what you mean by “you don’t know enough about the condition”? I told you exactly what the MRI said as well as what an orthopedic surgeon and podiatrist have recommended. Update now almost 1 year later (~10 months): I still feel it when I walk or run albeit not to the same degree (or maybe I’ve just learned to live with pain). Inflammation is far less and visible redness does not come back often and disappears quicker than before. I.e some signs of improvement. Plan is to continue strengthening the tendon back via PT as surgery would be undoing the progress made + a ~1 year recovery + no promise that it’ll be 100% better

[@DocOnTheRun]

With respect, although you may have told me what your MRI said, what your podiatrist said and what your orthopedist said, I still don’t know enough about the condition in your particular case. I would never be so irresponsible is to make a decision and/or recommendation for a patient without understanding the necessary variables to ensure the proper recommendation.

[@terriliggett544]

Hello. I recently had an MRI for my posterior tibial tendon pain, and the findings state tenosynovitis. I’ve had this condition for 1.5 years. The report also states that I have a 1cm tear of the peroneal brevis tendon. I rolled my left ankle about 9 months ago, but didn’t have symptoms. I now have some tenderness in that area that correlates to activity. I’m not doing much on that foot due to pttd. My surgeon is not keen to do anything about either tendon. Your video suggests that might be the wrong approach. I stopped running about one year ago. The pttd is very annoying, but I have not lost arch height and I can still do a single leg heel raise. The tendon is touchy/tender at the ankle and up the inner calf. Your advice is appreciated.

[@DocOnTheRun]

Hi Terri, Thank you for watching. I am really sorry to hear about your situation and that you don't seem to be getting clear direction from your doctor. That sounds very frustrating!

[@michaelahutto6795]

Haha How screwed am I? 1.6 inch tear in the peronous brevis tendon 55x24x33 mm mass and a chronically injured peronous longus tendon.

[@DocOnTheRun]

Thank you for watching and sharing your story with other runners.

[@Lily-b7s9p]

Hi Christopher, thanks for all your video’s, they’re absolutely brilliant! I’m a physio in the UK and my husband is a keen ultra runner. He’s just found out he has a 2.3cm split tear of the peroneus brevis, diagnosed via ultrasound, which is behind the lateral malleolus. There is also an associated lump in this region which was what led him to seek further imaging / medical attention. He’s been advised by a surgeon to continue with Physiotherapy, which he has been doing for the last 9 months. The information that you have provided about a peroneus brevis tear in this specific location makes complete sense, and we’ve spent many hours trying to find further information / evidence around the likeliness of a tear of this nature healing with time / patience / optimal loading and I wondered if there are any current studies / evidence that you may be able to point us in the direction of?