Peroneal tendon injuries and instability are a relatively uncommon cause of lateral hindfoot pain.
There are two main types of problems, which are related:
- Tears and tendonopathy, and the related “painful os perineum syndrome”
- peroneus brevis tears are commoner and tend to occur close to the fibula
- pernoneus longus tears occur on the lateral hindfoot, especially at the cuboid groove
- Instability of the tendons at the level of the superior peroneal retinaculum
There is also a strong association with lateral ankle ligament injuries and instability. Confusingly, peroneal tendon instability may be described by the patient as "my ankle gives way".
The incidence and prevalence of peroneal tendon problems has not been determined. In Blackburn we see 5-10 new patients a year in a population of 260,000 and 1300 new referrals, implying an incidence of the order of 30/million/year. However, this is a general foot and ankle practice without a large sports medicine component and some sporting injuries may be seen by club physiotherapists or surgeons elsewhere. The sex incidence is approximately equal.