The Centers for Advanced Orthopaedics
Maryland Orthopedic Specialists
A Division of The Centers for Advanced Orthopaedics
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Foot & Ankle

Peroneal Tendon Tears / Subluxation

The peroneal tendons are frequently injured, frequently missed, and frequently attributed to a "chronic ankle sprain." Peroneus brevis longitudinal split tears, peroneus longus tears, and subluxation of the tendons out of their fibular groove are distinct injuries with specific examination findings — and they will not resolve with generic ankle sprain rehabilitation. At Maryland Orthopedic Specialists, we identify and treat peroneal pathology precisely, from targeted physical therapy to surgical tendon repair and retinacular reconstruction.

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What is peroneal tendon tears / subluxation?

The peroneus brevis (PB) and peroneus longus (PL) tendons run posterior to the lateral malleolus, held in a groove on the fibula by the superior peroneal retinaculum (SPR). They are the primary evertors of the foot and lateral ankle stabilizers.

The peroneus brevis (PB) and peroneus longus (PL) tendons run posterior to the lateral malleolus, held in a groove on the fibula by the superior peroneal retinaculum (SPR). They are the primary evertors of the foot and lateral ankle stabilizers.

Peroneus brevis longitudinal split tears: The most common peroneal injury. The PB tendon, sandwiched between the fibular groove and the PL tendon, develops a longitudinal split — a "C-shape" or boomerang morphology on cross-section. Caused by chronic friction and repetitive eversion loads. Associated with hindfoot varus, lateral ankle instability, and a shallow fibular groove. Patients report lateral ankle pain and weakness; physical examination shows tenderness directly over the posterior fibula along the PB.

Peroneus longus tears: Less common; may occur at the os peroneum (a sesamoid bone in the PL as it curves under the cuboid) or along the lateral foot. Painful os peroneum syndrome and PL tears cause lateral foot and midfoot pain distinct from the typical posterior fibular pain of PB pathology.

Peroneal tendon subluxation / dislocation: The SPR is torn — typically in a sudden, forceful dorsiflexion-eversion mechanism (common in skiing and football) — allowing the tendons to snap anteriorly over the fibular tip. Patients often describe a "pop" and feel the tendon "flipping" over the ankle bone with certain movements. SPR tears are commonly missed acutely, mistaken for a simple ankle sprain.

Association with lateral ankle instability: Peroneal tendon pathology and chronic lateral ankle instability frequently coexist. Up to 25% of patients undergoing lateral ligament reconstruction have concurrent peroneal pathology identified at surgery.

Treatment options

Many peroneal tendon injuries improve with conservative care, though tears with significant instability typically require surgery.

Non-Operative Management

A walking boot or cast rests the tendons and reduces inflammation during the acute phase. Physical therapy focusing on peroneal strengthening and balance training helps restore function. An ankle brace provides ongoing support during return to sport.

Surgical Procedure

Peroneal Tendon Repair

Repair of longitudinal peroneal tendon tears combined with reconstruction of the superior peroneal retinaculum to prevent recurrent subluxation. Addresses both the tendon damage and the anatomic instability responsible for the condition.

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Ankle Arthroscopy

Minimally invasive joint scope to treat intra-articular ankle pathology — osteochondral lesions, anterior bony impingement, and synovitis — through small portals with same-day discharge at our ambulatory surgery center.

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Frequently Asked Questions

Is peroneal subluxation the same as a sprain?
No. A sprain injures the lateral ligaments (ATFL, CFL); subluxation injures the superior peroneal retinaculum. Both can occur simultaneously, but subluxation requires targeted SPR evaluation and, if persistent, surgical reconstruction. Generic sprain rehabilitation will not stabilize a torn retinaculum.
Can peroneal tendon tears heal on their own?
Partial peroneal tendon tears, particularly those associated with tenosynovitis without frank instability, can improve with non-operative management. Complete SPR tears causing recurrent subluxation rarely heal without surgery.
What happens if subluxation is untreated for years?
Chronic peroneal subluxation progressively damages both tendons from repeated friction, and the fibular groove becomes increasingly eroded. Long-standing subluxation can complicate surgical repair significantly, making early recognition and treatment preferable.
Will I need surgery for a peroneal tendon tear or subluxation?
Not all peroneal tendon injuries require surgery. Partial tears that cause pain and swelling are often managed with a period of immobilization in a boot, physical therapy, and activity modification — many improve with conservative care over 6–12 weeks. However, subluxation (the tendon snapping out of its groove) rarely resolves permanently without surgery because the retinaculum that holds the tendon in place does not reliably heal. Your MOS surgeon will assess the severity of your tear and whether subluxation is present to determine the most appropriate course of action.
How long is recovery after peroneal tendon surgery?
After peroneal tendon repair or groove-deepening surgery for subluxation, patients are typically non-weight-bearing in a splint or boot for 2–4 weeks, followed by protected weight-bearing and gradual progression in physical therapy. Most patients are walking comfortably without support by 6–8 weeks and can return to lower-impact activities at 3–4 months. Return to cutting sports and high-demand activities typically takes 5–6 months. At MOS, your rehabilitation is individualized based on the specific procedure performed and your sport or activity goals.

Meet the specialists

Gary Feldman, DPM, FACFAS

Gary Feldman, DPM, FACFAS

Podiatry (Foot & Ankle Surgery)

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Related conditions

Ankle Sprains / Chronic Lateral Ankle InstabilityAnkle OsteoarthritisFoot & Ankle Fractures
Medically reviewed by Gary Feldman, DPM, FACFAS, DPM, FACFAS
Last reviewed May 1, 2026

References

  1. Roster B, Michelier P, Giza E. Peroneal tendon disorders. Clinics in Sports Medicine. 2015;34(4):625–641. doi:10.1016/j.csm.2015.06.003
  2. Demetracopoulos CA, Vineyard JC, Kiesau CD, Nunley JA. Long-term results of debridement and primary repair of peroneal tendon tears. Foot & Ankle International. 2014;35(3):252–257. doi:10.1177/1071100713513183
  3. van Dijk PA, Lubberts B, Verheul C, DiGiovanni CW, Kerkhoffs GM. Outcome of peroneal tendon surgery: a systematic review. Acta Orthopaedica. 2016;87(2):198–204. doi:10.3109/17453674.2015.1110278
  4. OrthoInfo — AAOS. Peroneal Tendon Injuries. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/peroneal-tendon-injuries