What is the treatment for a peroneus brevis split tear?

From the Guidelines

The treatment for a peroneus brevis split tear should initially focus on conservative management, prioritizing rest, ice, compression, and elevation (RICE protocol) for 2-6 weeks, as this approach is crucial for reducing morbidity and improving quality of life. This initial step is supported by the understanding that up to 34% of asymptomatic patients may have a tear of the peroneus brevis tendon, as noted in a study published in the Journal of the American College of Radiology 1, highlighting the potential for conservative management to be effective.

Conservative Management

• The RICE protocol is fundamental in the initial treatment phase to minimize inflammation and promote healing.
• Anti-inflammatory medications, such as ibuprofen (400-800mg three times daily) or naproxen (250-500mg twice daily), can be used to reduce pain and inflammation, although their use should be carefully considered to minimize potential side effects and maximize quality of life.
• Physical therapy, including progressive strengthening exercises, proprioception training, and range of motion exercises for 6-12 weeks, is vital for restoring function and preventing future injuries, thus directly impacting morbidity and mortality by reducing the risk of complications.

Surgical Intervention

For cases where conservative management fails to yield significant improvement after 3-6 months, surgical intervention, such as direct repair of the split tear, tendon debridement, or in severe cases, tendon transfer, may be necessary to prevent chronic ankle instability and recurrent injuries, thereby reducing long-term morbidity and improving quality of life. The decision for surgery should be made cautiously, considering the potential risks and benefits, and the importance of preserving ankle function to maintain quality of life, as evidenced by the high sensitivity of MRI in diagnosing ankle tendon tears, including peroneal tendinopathy and tendon tears 1.

Rehabilitation

Following surgical intervention, immobilization for 2-4 weeks, followed by a structured rehabilitation program lasting 3-6 months, is essential for optimal recovery and return to function, minimizing the risk of complications and directly improving quality of life. Custom orthotics or ankle braces may provide additional support during the healing process, both pre- and post-surgery, to enhance stability and reduce the risk of further injury.

From the Research

Treatment Options for Peroneus Brevis Split Tear

The treatment for a peroneus brevis split tear can be divided into non-operative and operative methods.

• Non-operative treatment includes:
  • Supportive therapy with ankle bracing and analgesics 2
  • Physical therapy targeted at the peroneus brevis tendon 3
  • Ultrasound-guided peroneal tendon sheath corticosteroid injection 4
• Operative treatment options include:
  • Debridement and repair of the torn tendon 2, 5, 6
  • Excision of the nonviable segment and tenodesis of the damaged tendon to the adjacent peroneal tendon 5, 6
  • Flexor tendon transfer and/or allograft reconstruction for irreparable tearing of both peroneal tendons 5, 6
  • Tubularization or resection of the damaged tendon and tenodesis in severe cases 2

Considerations for Treatment

The choice of treatment depends on the severity of the tear, the patient's symptoms, and their overall health.

• Patients with ongoing symptoms may require surgical repair 2
• A trial of conservative treatment may be considered in lower-demand middle-aged patients 3
• The duration of symptoms prior to injection is associated with the post-injection duration of pain relief 4