From the Guidelines
The initial treatment for a peroneus brevis tendon partial tear is conservative management focusing on rest, ice, compression, and elevation (RICE protocol). Patients should avoid activities that cause pain and may use a walking boot or ankle brace for 4-6 weeks to immobilize and protect the tendon. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) can help manage pain and reduce inflammation, as suggested by 1. Once acute pain subsides, typically after 1-2 weeks, physical therapy should begin with gentle range-of-motion exercises, gradually progressing to strengthening exercises targeting the peroneal muscles. Eccentric strengthening exercises are particularly beneficial for tendon healing. This conservative approach is effective because most partial tears heal well without surgery when given adequate time and protection, with about 80 percent of patients fully recovering within three to six months 1. The rehabilitation process typically takes 6-12 weeks, depending on tear severity.
Surgery is only considered if conservative treatment fails after 3-6 months or for high-grade tears in athletes requiring faster return to sport, as noted in 1. Ultrasound (US) can be used to evaluate for soft-tissue abnormalities, including tendon and ligament tears, and has been shown to produce similar results as MRI in diagnosing ankle tendon tears, although US results are more dependent on operator skill and expertise 1. US can also be used to guide interventions such as concurrent performance of US-guided intrasheath anesthetic injections, direct intratendinous biologic injection, and dry needling 1.
Key points to consider in the treatment of peroneus brevis tendon partial tear include:
- Avoiding activities that cause pain
- Using a walking boot or ankle brace for immobilization
- Managing pain and inflammation with NSAIDs
- Gradually progressing to strengthening exercises targeting the peroneal muscles
- Considering surgery only if conservative treatment fails or for high-grade tears in athletes.
From the Research
Initial Treatment for Peroneus Brevis Tendon Partial Tear
The initial treatment for a peroneus brevis tendon partial tear typically involves conservative measures.
- Non-operative treatment options include nonsteroidal anti-inflammatory drugs, activity modification, physical therapy, and immobilization 2.
- Ultrasound-guided peroneal tendon sheath corticosteroid injection is also a non-operative modality that can be considered for symptomatic peroneal tendinopathy or tears 2.
- A trial of conservative treatment, including peroneus brevis targeted physical therapy, can be effective in managing peroneal split syndrome, especially in lower-demand middle-aged patients 3.
Surgical Treatment
Surgical treatment is typically reserved for cases where conservative measures fail or for more severe tears.
- Débridement and repair are recommended for less extensive tears, while resection of the damaged tendon and tenodesis of the proximal and distal segments to the peroneus longus may be necessary for more severe cases 4, 5.
- Excision of the nonviable segment and tenodesis of the damaged tendon to the adjacent peroneal tendon may also be considered 6.
Treatment Outcomes
The outcomes of treatment for peroneus brevis tendon partial tears can vary depending on the severity of the tear and the treatment approach.