What is peroneus longus tendon repair?

What is Peroneus Longus Tendon Repair?

Peroneus longus tendon repair is a surgical procedure to fix a torn or severely damaged peroneus longus tendon—one of two tendons running along the outer side of your ankle that helps stabilize your foot and ankle during walking and movement.

Understanding the Peroneus Longus Tendon

The peroneus longus is a tendon that:

• Runs from the outer leg, behind the ankle bone (fibula), and wraps under the foot 1
• Works together with the peroneus brevis tendon to stabilize the ankle and prevent it from rolling outward 2
• Can tear from chronic overuse, ankle injuries, or problems with a small bone called the os peroneum that sits within the tendon 2

When Repair is Needed

Your surgeon may recommend repair when:

• The tendon has a complete tear or severe damage that cannot heal on its own 1
• Conservative treatments like rest, physical therapy, bracing, and anti-inflammatory medications have failed 3
• You experience persistent lateral ankle pain, weakness, and instability that limits daily activities 1, 2

Types of Surgical Repair

Direct Repair

• Used when the torn tendon ends can be sewn back together 1
• The surgeon makes an incision along the outer ankle to access and suture the torn tendon 1

Tendon Transfer (For Severe Tears)

When the peroneus longus is too damaged to repair directly:

• The surgeon transfers another tendon—typically the flexor hallucis longus (FHL) or flexor digitorum longus (FDL)—to replace the function of the damaged peroneus longus 1, 4
• This is particularly necessary when both the peroneus longus and brevis tendons are severely torn 1, 4
• The transferred tendon is attached to the remaining peroneus brevis to restore ankle stability 1, 4

Tenodesis (Connecting Tendons)

• If the peroneus brevis is intact but the longus is irreparable, the surgeon may remove the damaged portion of the longus and attach (tenodese) it to the brevis 2
• This is especially common when there's a fractured or enlarged os peroneum causing the tear 2

What to Expect After Surgery

Recovery Timeline

• Initial immobilization in a cast or boot for several weeks 5
• Transition to a brace with gradual weight-bearing as healing progresses 5
• Supervised physical therapy focusing on proprioception (balance), strength, coordination, and functional activities 5
• Most patients return to preoperative activity levels within several months 1

Outcomes

• Studies show significant improvement in pain scores and ankle function after repair 1, 2
• 87.5% of patients report satisfaction with surgical results following tendon transfer for severe tears 1
• Return to sports and daily activities without bracing is achievable in most cases 1, 4

Potential Complications

While generally successful, be aware of:

• Nerve injury (particularly sural nerve), causing numbness or tingling along the outer foot 1, 2
• Wound healing problems or superficial infections 2
• Rare need for additional procedures if biomechanical issues persist 1

Important Considerations

Dynamic ultrasound is the best imaging test to diagnose peroneal tendon problems before surgery, with 100% accuracy compared to surgical findings 5. This helps your surgeon plan the appropriate repair technique.

The key to successful recovery is structured, supervised rehabilitation rather than arbitrary timeframes—your return to activities should be based on functional recovery, not just calendar dates 5.