Professional Soccer Athlete With A Tender Lateral Ankle Nodule - Page #4
 

Working Diagnosis:
Ankle sprain.

Treatment:
The athlete was initially treated with a lace-up ankle brace, non-steroidal anti-inflammatory medications, rest, ice protocol, and physical therapy for two weeks.

Outcome:
The athlete did not improve and had persistent pain. MRI was ordered Case Photo #1 Case Photo #2 Case Photo #3 . The images uncovered peroneus longus tendon rupture.

Author's Comments:
Patients presenting with ankle pain rarely have involvement of the peroneus longus as the etiology. Peroneus longus tendon injuries can present as incomplete longitudinal, partial, or as a complete transverse tear (Clarke et al. 1998). Acute injury to this tendon usually occurs after significant ankle inversion, tendon subluxation, or fracture of the os peroneum (Bassett et al., 1993, Truong et al., 1995). Quick diagnosis and treatment is key for good patient outcomes and satisfaction (Arbab et al. 2014). Surgical management is the standard of treatment, and has shown to be successful with predictable outcomes. A delay in diagnosis and treatment of a peroneal tendon rupture can be complicated by recurrent ankle sprains and instability (Wind et al., 2001). Our case highlights the importance of a good physical exam, which subsequently lead to appropriate imaging, diagnosis, and treatment of a peroneus longus tendon rupture.

Editor's Comments:
Peroneal brevis is more common than Peroneal longus.

The peroneus longus functions as the primary evertor of the foot, first metatarsal plantarflexor, and secondary ankle plantarflexor.

A common causes of tears of the longus tendon is associated with a varus deformity of the heel or a cavovarus foot deformity

terrific review article:
Cerrato R, Myerson M. Peroneal Tendon Tears, Surgical Management and Its Complications. Foot and Ankle Clinics, 2009-06-01, Volume 14, Issue 2, Pages 299-312

References:
Arbab, D., Tingart, M., Frank, D., Abbara-Czardybon, M., Waizy, H., & Wingenfeld, C. (2014). Treatment of Isolated Peroneus Longus Tears and a Review of Literature. Foot and Ankle Specialist, 7, 113-118.

Bassett, F.H. 3rd, & Speer, K.P. (1993). Longitudinal rupture of the peroneal tendons. American Journal of Sports Medicine, 21, 354-357.

Clarke, H., Kitaoka, H., & Ehman, R. (1998). Peroneal tendon injuries. Foot & Ankle International, 19, 280-288.

Truong, D.T., Dussault, R.G., & Kaplan, P.A. (1995). Fracture of the osperoneum and rupture of the os peroneus longus tendon as a complication of diabetic neuropathy. Skeletal Radiology, 24, 626-628.

Wind, W.M., & Rohrbacher, B.J. (2001). Peroneus Longus and Brevis Rupture in a Collegiate Athlete. Foot & Ankle International, 22, 140-143.

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