What is the management approach for a patient with small peroneus longus tenosynovial fluid without hyperemia, suggesting a nonspecific condition without active tenosynovitis?

From the Guidelines

The management approach for a patient with small peroneus longus tenosynovial fluid without hyperemia should focus on conservative treatment, prioritizing relative rest, activity modification, and symptom management. This approach is based on the understanding that the absence of hyperemia suggests a nonspecific condition without active tenosynovitis, and thus, aggressive interventions are not initially warranted.

Key Components of Conservative Management

• Relative rest and activity modification to reduce stress on the peroneal tendons
• Application of ice for 15-20 minutes several times daily to reduce mild swelling
• Use of over-the-counter NSAIDs, such as ibuprofen (400-600mg three times daily with food) or naproxen (220-440mg twice daily), for 1-2 weeks to manage discomfort, as suggested by treatment guidelines for similar conditions 1
• Physical therapy focusing on ankle strengthening and proprioception exercises for 4-6 weeks
• Proper footwear with adequate lateral support, and temporary use of an ankle brace or supportive taping during activities

Given the nonspecific nature of the finding and the absence of active inflammation, conservative management is the preferred initial approach, aiming to alleviate symptoms and promote recovery without unnecessary interventions. Most patients are expected to improve within 4-6 weeks with these measures. If symptoms persist beyond 6-8 weeks despite adherence to conservative management, further evaluation, including additional imaging or specialist referral, may be necessary to reassess the condition and consider alternative treatment strategies 1.

From the Research

Management Approach

The management approach for a patient with small peroneus longus tenosynovial fluid without hyperemia, suggesting a nonspecific condition without active tenosynovitis, can be considered based on the following points:

• The presence of tenosynovial fluid without hyperemia may indicate a non-inflammatory condition, and the management should focus on addressing the underlying cause of the fluid accumulation.
• The peroneus longus tendon plays a crucial role in maintaining the arch integrity of the foot, and any weakness or overload in this tendon can lead to various foot disorders 2.
• Conservative management, including rest, nonsteroidal anti-inflammatory medication, and physical therapy, may be considered as the initial treatment approach for patients with peroneus longus tenosynovitis 3.
• In cases where conservative management fails, surgical intervention, such as synovial débridement or tendon repair, may be necessary 3, 4.
• The use of corticosteroid injections has been shown to be effective in treating De Quervain's tenosynovitis, a condition similar to peroneus longus tenosynovitis, with significant improvement in symptoms and reduction in pain 5, 6.

Key Considerations

• The management approach should be individualized based on the patient's specific condition, medical history, and response to treatment.
• A thorough evaluation of the patient's foot and ankle should be performed to identify any underlying structural deformities or weaknesses that may be contributing to the condition.
• The patient should be closely monitored for any signs of worsening symptoms or adverse reactions to treatment, and adjustments to the management approach should be made as necessary.