Injuries to the peroneal tendons include tendinopathy (peritendinosis, tenosynovitis, tendinosis), rupture, and dislocation.
The peroneus longus tendon tear or tendinopathy usually occurs at three major locations: at the lateral malleolus, at the peroneal tubercle of the calcaneus, and in the notch on the plantar surface of the cuboid (cuboid tunnel).
MR imaging findings include morphologic and signal intensity abnormalities within the tendon representing partial or complete disruption.
Ax GRE T2 Fat Sat
Ax GRE T2 Fat Sat (lower cut)
Mag View
Sag T2 Fat Sat
Cor T2 Fat Sat
37 yo with lateral ankle pain
Injuries to the peroneal tendons include tendinopathy (peritendinosis, tenosynovitis, tendinosis), rupture, and dislocation. The rupture can be transverse or, more commonly, longitudinal split. These occur in young, athletic individuals due to overuse or may be related to degenerative wear and tear in older, more sedentary patients.
The peroneus longus tendon tear or tendinopathy usually occurs at three major locations: at the lateral malleolus, at the peroneal tubercle of the calcaneus, and in the notch on the plantar surface of the cuboid (cuboid tunnel). Tears of the peroneus longus tendon may be associated with peroneus brevis tendon tears at the level of the lateral malleolus.
MR imaging findings include morphologic and signal intensity abnormalities within the tendon representing partial or complete disruption.
This case demonstrates peroneus brevis tendon to be partially medial to the medial edge of the fibular groove on axial plane and peroneus longus tendon in the retromalleolar groove. This is a normal finding (normal variant) encountered as pseudosubluxation of peroneus brevis tendon which is usually more prominent in supination. We speculate that the persistent gliding motion of the peroneus longus tendon in the retromalleolar groove may lead to increased stress on the tendon, which could have it predisposed to tear in this case. The peroneus longus tendon itself is thickened and demonstrates focal increased intrasubstance signal in the region from the retromalleolar groove to distal to the cuboid tunnel.
Suggested reading:
Cees C. P. M. Verheyen, Johannes Bras, and C. Niek van Dijk. Rupture of Both Peroneal Tendons in a Professional Athlete: A Case Report. The American Journal of Sports Medicine 28:897-900 (2000).
Rademaker J, Rosenberg ZS, Delfaut EM, Cheung YY and Schweitzer ME. Tear of the Peroneus Longus Tendon: MR Imaging Features in Nine Patients. Radiology. 2000;214:700-704.
Xiao-Tian Wang, Zehava Sadka Rosenberg, Michael B. Mechlin, and Mark E. Schweitzer. Normal Variants and Diseases of the Peroneal Tendons and Superior Peroneal Retinaculum: MR Imaging Features. RadioGraphics 2005; 25: 587-602.
Kulenovic, E. Transverse Rupture of Peroneus Longus Tendon. A Case Report. www.mskcases.com July 31, 2006.
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