The peroneal tubercle: description, classification, and relevance to peroneus longus tendon pathology

BACKGROUND: The size and configuration of the peroneal tubercle has been implicated in the pathogenesis of peroneal tendon tears and tenosynovitis. The purpose of this study was to determine the size and prevalence of the peroneal tubercle and devise a classification scheme according to the structure of the tubercle. METHODS: One hundred and seventeen calcanei were selected from 59 human skeletons in an osteological collection (one calcaneus was missing). Three were excluded because of the poor condition, leaving 114 calcanei. The peroneal tubercle was measured in length, height, and depth and its structure subjectively described as flat, prominent, concave, or tunnel for each specimen when present. RESULTS: This study revealed a peroneal tubercle prevalence of 90.4% (103) in 114 calcanei. The average length, height, and depth of the tubercle were 13.04 mm (range 3.61 mm to 26.66 mm), 9.44 mm (range 3.67 mm to 23.40 mm), and 3.13 mm (range 1 to 10), respectively. The peroneal tubercle was classified structurally as flat in 44 (42.7%), prominent in 30 (29.1%), concave in 28 (27.2%), and tunnel in one (1.0%). CONCLUSION: This data may further help to understand the size and assorted configurations of the peroneal tubercle and how they relate to peroneus longus tendon pathology.     

Stenosing tenosynovitis and impingement of the peroneal tendons associated with hypertrophy of the peroneal tubercle.

We report three patients with lateral ankle and foot pain, with the diagnosis of stenosing tenosynovitis of the peroneus longus tendon associated with a markedly enlarged peroneal tubercle. Stenosing tenosynovitis of the peroneus longus tendon associated with an atraumatically enlarged peroneal tubercle has rarely been reported, and these reported cases were associated with an os peroneum. One of our patients had no demonstrable associated os peroneum but did have a bony tunnel enveloping the peroneus longus tendon. Our other two patients had an os peroneum, but were asymptomatic at the lateral outer border of the cuboid tunnel; one patient had involvement of the peroneus longus and brevis tendons.     

Common peroneal nerve palsy secondary to peroneus longus abscess: case report

Muscle abscess presenting as nerve palsy is rare and has not been previously reported in the common peroneal nerve (CPN). The objective of this case report is to describe the diagnosis and treatment of an uncommon presentation of peroneal abscess in the leg of an otherwise healthy man. We present a case of CPN palsy in a 50-year-old immunocompetent man with no other comorbid medical condition secondary to peroneus longus abscess. The diagnosis was suggested by magnetic resonance imaging examination and confirmed by intraoperative findings. After surgical drainage of the abscess, the patient made a complete recovery. A review of the literature confirms that peroneus longus abscess giving rise to CPN palsy has not been described. Early diagnosis and surgical drainage of the compressing abscess can produce a favorable outcome.     

Stenosing peroneal tenosynovitis

The etiology, diagnosis and surgical treatment of stenosing tenosynovitis of the peroneal tendons is presented. The authors stress the need for thorough understanding of this clinical entity as its symptomatology can mimic several more frequently encountered podiatric pathologies. This could result in delayed or missed diagnosis and, thus, improper management.     

Complete replacement of the peroneus longus muscle by a ganglion with compression of the peroneal nerve: a case report.

In a 38-year-old woman, the entire muscle belly of the peroneus longus was replaced by a ganglion. Signs of peroneal nerve dysfunction resulted from direct pressure of the ganglion. Excision of the ganglion required a tenodesis of the peroneus longus tendon to provide a normal gait pattern which was maintained during a 17 month follow-up period. This entity needs careful, prompt evaluation to avoid neurological damage and to distinguish it from compartment syndrome.     

Cavernous hemangioma behaving like peroneal tenosynovitis

Hemangioma of the tendon sheath is rarely reported. In this case report, a 22-year-old man, who had been seen for peroneal tenosynovitis before (although symptoms remained) was reevaluated. A cavernous hemangioma was located in the peroneal muscle and the tendon. Complete excision was performed.     

The influence of insoles with a peroneal pressure point on the electromyographic activity of tibialis anterior and peroneus longus during gait

Background

Peroneus longus acts as a foot evertor and pronator, thus ensuring stability of the talocrural joint by curbing inversion movement of the rearfoot. Increased activation of the peroneus longus muscle in the stance phase could have a stabilising effect on the ankle joint. This study aimed to determine whether the activity of the peroneus longus muscle could be increased by the targeted use of a specially formed lateral pressure element in a customised orthopaedic insole.

Methods

This was a laboratory-based study that utilised a randomised crossover design. Thirty-four healthy participants walked along a walkway in neutral footwear wearing a control insole or a sensorimotor insole with a lateral pressure point adjacent to the tendon of the peroneus longus muscle. The electromyographic muscle activity of the peroneus longus and tibialis anterior muscles was measured using surface electromyography. Contact with the ground was recorded via two pressure sensors under the sole of the shoe. Muscle activity during the stance phase was analysed in the time and amplitude domains and compared statistically with paired t-tests for both insole types.

Results

In 27 out of the 34 participants, an additional activity peak of the peroneus longus muscle was observed in the loading response phase with the sensorimotor insole, which reached its maximum at 29.7 % (±4.5 %) of the stance phase. When averaged over all 34 participants, the integrated electromyographic output for the peroneus longus in the mid-stance phase revealed a significant higher activity (p?<?0.001, post hoc power?=?0.98, effect size: Cohen’s d?=?0.71) with the sensorimotor insole (18.1?±?11.3 % MVCs) than with the control insole (11.2?±?7.7 % MVCs). No significant effects were established for the other gait phases or for the tibialis anterior.

Conclusions

An increase of muscle activity of the peroneus longus muscle was observed during the loading response and mid-stance phase, when orthopedic insoles with a lateral pressure point were worn. We conclude that the pressure point changes afferent information and leads to an increased peroneus longus activation in the time interval in which the pressure point exerted pressure on the peroneal tendon.

     

Osteochondroma of the peroneal tubercle

Summary We report two patients with pain on the lateral side of the ankle and foot which was due to stenosing tenosynovitis of the peroneal tendons caused by an osteochondroma of the peroneal tubercle. Surgical treatment produced a good result in both cases. The condition is uncommon, but should be borne in mind as a possible cause of pain in this region.

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Résumé Les auteurs présentent deux patients souffrant d'une douleur externe de la cheville et du pied depuis plusieurs années et d'étiologie rare: Teno-synovite sténosante des tendons péroniers à la suite du développement d'un ostéochondrome du tubercule des péroniers. Le traitement chirurgical a donné de bons résultats dans les deux cas. L'un des patients présente une symptomatologie similaire du côté opposé. Il ne faut pas oublier cette possibilité de diagnostic face à d'autres étiologies beaucoup plus fréquentes.

     

腓骨长肌腱转移术治疗陈旧性跟腱断裂

[目的]探讨利用腓骨长肌腱治疗陈旧性跟腱断裂的手术方法和经验. [方法]将腓骨长肌腱在远端处切断,经皮下隧道移位修复跟腱断裂. [结果]根据Arner-Lindholm评定标准,优11例,良10例.未发生跟腱再次断裂.2例出现伤口延迟愈合,经康复训练,所有患者均在术后10周左右弃拐完全负重行走. [结论]用腓骨长肌腱治疗断端缺损较多,或者肌腱在跟骨结节附近断裂的陈旧性跟腱断裂是一种疗效满意,康复较快的手术方法.     

Significance of sesamoid ossification in peroneus longus tendon ruptures

Ruptures of the peroneus longus tendon are uncommon, with a small number of case reports found in published studies. The presence of an os peroneum can predispose the peroneus longus tendon to rupture at the cuboid level with or without concomitant fracture, or fracture through a partite os peroneum. Whether the os peroneum can be represented by various stages of ossification is still a matter of debate. We present 2 cases of acute peroneus longus tendon rupture at the cuboid notch in the presence of an intact os peroneum in the ossified and nonossified form. We treated patients with excision of the os peroneum and tenodesis of the peroneus longus to the peroneus brevis tendon.