The peroneus brevis tendon attaches the peroneus brevis muscle to the fibula, or lower leg bone, at one end and to the bottom of the fifth metatarsal at the base of the little toe. Injuries to this tendon can be caused by overuse or repetitive motion, such as running; by ankle sprains; or by degenerative processes. If you suffer a torn tendon, you will need surgery to repair it. Before surgery, you can treat your injury with rest and pain medication. After surgery, you also can undergo physical therapy and might need a brace or walking boot while the tendon heals.
The peroneus brevis muscle and tendon work in concert with two other peroneal muscle and tendon pairs: the peroneus longus muscle and tendon and the peroneus tertius muscle and tendon. Together, these three pairs control the downward and outward movement of the foot. The peroneus brevis tendon and peroneus longus tendon merge in a sheath behind the ankle. When the corresponding muscles are flexed, the tendons slide inside the sheath.
Symptoms of injury to the peroneus brevis tendon include swelling as well as pain at the base of the little toe or in the outer ankle area. A healthcare professional will conduct a physical exam to diagnose the cause of the pain and might order an X-ray to rule out a fracture or other injury or a magnetic resonance imaging (MRI) scan to reveal a torn tendon, scarring or swelling. If the MRI does not reveal a tear, the preferred course of treatment for mild to moderate pain is to rest the affected foot, which might include wearing a walking boot or, in mild cases, an ankle brace, arch support for high arches or a heel wedge. The immobilizing or supporting devices are used for two to four weeks. Non-steroidal anti-inflammatory drugs such as ibuprofen or naproxen frequently are recommended for pain relief.
Surgical treatment will be considered only when tendon pain fails to respond to nonsurgical treatment or if the tendon is torn. The type of procedure indicated depends on the source of pain and the nature of your injury. Both tendon release surgery and debridement are used to treat tenosynovitis and ankle tendonosis by removing damaged tissue from around the tendon. Debridement requires more extensive tissue removal than tendon repair surgery.
If your MRI reveals a torn peroneus brevis tendon, surgery is required. When the tear is short, the torn portion of the tendon might be removed and the end of the tendon reattached to the bone or, in mid-tendon tears, sutured together in the middle of the tendon. For more extensive, longer tendon tears, the tear is sutured. Recovery from release, debridement or repair can take up to four months and includes wearing a cast for up to six weeks, then wearing a walking boot for another four. One to two months of physical therapy also is typically recommended after the cast is removed.
Treatment might also include physical therapy, which can include the use of heat, ice or ultrasound to alleviate swelling and irritation. Stretching and strengthening exercises also might be used to improve tendon and overall ankle health. Cortisone injections into the tendon are occasionally used, but only as a last resort because there is a risk of rupture.