Peroneal tendons are crucial structures on the outer side of the ankle that help with movements like turning the foot outward (eversion). Injuries to these tendons, especially tears or ruptures, are common causes of ankle pain and dysfunction. These injuries often go unnoticed or are mistaken for simpler ligament injuries, which is why it’s important for healthcare providers to thoroughly examine the area and conduct appropriate tests to confirm the diagnosis.
When more than half of the tendon is damaged, non-surgical treatments like rest, physical therapy, and anti-inflammatory medications are typically the first course of action. However, if these methods don’t provide relief, surgery might be needed. One surgical option involves transferring the peroneus longus tendon to replace the damaged peroneus brevis tendon.
Why the Peroneus Brevis to Longus Transfer?
The peroneus longus tendon, when transferred to the brevis tendon, serves as a substitute for the damaged tendon. This transfer can help restore normal ankle function, allowing for movements like eversion (turning the foot outward) and inversion (turning the foot inward). This procedure is particularly useful for patients with severe tendon damage.
How the Procedure Works
The surgery involves making an incision on the outer side of the ankle to access the tendons. The damaged peroneus brevis tendon is removed, and the peroneus longus tendon is carefully moved and reattached at the foot. The procedure ensures that the new tendon insertion restores normal ankle motion without compromising strength. The peroneus longus tendon’s role in helping the foot turn outward (eversion) is key in this transfer.
This transfer is usually performed when more than 50% of the peroneus brevis tendon is damaged, and it offers a more robust and durable solution than other methods like tendon suturing or simple debridement.
Benefits of Peroneus Longus to Brevis Transfer
Restoration of Strength and Function: The study found that patients who underwent the tendon transfer had similar strength and range of motion in their ankles compared to the healthy ankle. This means that the transfer does not limit the ability to turn the foot outward or inward.
Improved Clinical Scores: After surgery, patients showed improvement in clinical outcomes, as evidenced by their scores on various functional and pain scales (e.g., AOFAS hindfoot score, German Foot Function Index). These scores measure how well the ankle is functioning and the level of pain, with higher scores indicating better outcomes.
Post-Operative Care
After surgery, the ankle is kept immobilized for a few weeks to allow for healing. Patients typically use crutches to keep weight off the ankle for up to six weeks. Following this period, a stepwise approach to rehabilitation, including physical therapy, helps patients regain full function and strength.
Conclusion
The peroneus longus to brevis tendon transfer is a reliable and effective surgical option for patients with severe damage to the peroneus brevis tendon. The procedure helps restore normal ankle function without compromising strength or range of motion. Patients can expect significant improvements in clinical and functional outcomes, with a relatively straightforward recovery process.
