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What Is Peroneal Tendon Repair?

Peroneal tendon repair is surgery used to treat a torn peroneus brevis or peroneus longus tendon along the outer side of the ankle and foot. These tendons help evert the foot, support the arch, and stabilize the ankle during walking and athletic activity. Repair can involve removing damaged tendon tissue and suturing the remaining tendon into a stronger tubular shape. More advanced tears can require tenodesis to the neighboring peroneal tendon, tendon transfer, or graft reconstruction.

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What Is Peroneal Tendon Repair?

Peroneal tendon repair is surgery used to treat a torn peroneus brevis or peroneus longus tendon along the outer side of the ankle and foot. These tendons help evert the foot, support the arch, and stabilize the ankle during walking and athletic activity. Repair can involve removing damaged tendon tissue and suturing the remaining tendon into a stronger tubular shape. More advanced tears can require tenodesis to the neighboring peroneal tendon, tendon transfer, or graft reconstruction.

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Why Is Peroneal Tendon Repair Performed?

Surgery is considered when a peroneal tendon tear causes persistent lateral ankle pain, weakness, swelling, instability, or loss of function despite appropriate nonsurgical treatment. Acute complete ruptures and mechanically unstable tears can also require operative treatment. Magnetic resonance imaging, ultrasound, examination, tendon quality, and the amount of viable tissue help determine whether direct repair is possible. Surgeons also evaluate tendon subluxation, hindfoot alignment, and the superior peroneal retinaculum because these problems can contribute to recurrent injury.

How Is Peroneal Tendon Repair Performed?

The surgeon exposes the injured tendon behind or below the lateral malleolus and removes frayed or nonviable tissue. A repairable longitudinal tear can be sutured and tubularized to restore tendon continuity and shape. When too little healthy tendon remains, the damaged tendon can be joined to the adjacent peroneal tendon or reconstructed with a graft or tendon transfer. Retinacular repair, groove deepening, or correction of hindfoot deformity can be added when instability or abnormal mechanics contributed to the tear.

What Is Recovery Like After Peroneal Tendon Repair?

The ankle is protected in a splint, cast, or boot while the tendon and any associated repair begin to heal. Weight-bearing and ankle motion are restricted initially according to tendon quality, repair strength, and additional procedures. Physical therapy later progresses range of motion, eversion strength, balance, gait, and return to sport. Recovery commonly takes several months, especially after tenodesis, graft reconstruction, or combined stabilization surgery.

What Are the Risks and Complications?

Possible complications include infection, wound problems, stiffness, persistent pain, tendon adhesions, weakness, and recurrent tearing. The sural nerve lies close to the operative area and can be irritated or injured, causing numbness or painful sensitivity along the outer foot. Repaired tendons can remain unstable or develop recurrent subluxation when associated retinacular or bony problems persist. Some patients require revision repair, tenodesis, graft reconstruction, or additional treatment for ongoing symptoms.

Frequently Asked Questions About Peroneal Tendon Repair

Which tendons are treated during peroneal tendon repair?

The procedure can treat the peroneus brevis, peroneus longus, or both tendons depending on the injury.

What is tendon tubularization?

Tubularization reshapes a split or flattened tendon after damaged tissue is removed. Sutures restore a more normal tendon contour and strengthen the remaining viable tissue.

What happens if a peroneal tendon cannot be repaired directly?

The surgeon can use tenodesis to the neighboring peroneal tendon, a tendon transfer, or an allograft reconstruction when the remaining tissue is not suitable for primary repair.

Can peroneal tendon instability be treated during the same surgery?

Yes. Superior peroneal retinaculum repair, fibular groove deepening, or other stabilization procedures can be added when tendon subluxation or dislocation is present.

References

Peroneal Tendinosis Symptoms & Causes. FootCareMD, American Orthopaedic Foot & Ankle Society. https://www.footcaremd.org/foot-and-ankle-conditions/ankle/peroneal-tendinosis. Date Accessed August 13, 2026.

Peroneal Tendon Syndromes. StatPearls (NCBI Bookshelf). https://www.ncbi.nlm.nih.gov/books/NBK544354/. Date Accessed August 13, 2026.

Diagnosis and Operative Treatment of Peroneal Tendon Tears. PubMed Central (PMC). https://pmc.ncbi.nlm.nih.gov/articles/PMC8697126/. Date Accessed August 13, 2026.

Operative treatment for peroneal tendon disorders. PubMed. https://pubmed.ncbi.nlm.nih.gov/18245603/. Date Accessed August 13, 2026.

The ESSKA-AFAS international consensus statement on peroneal tendon pathologies. PubMed. https://pubmed.ncbi.nlm.nih.gov/29767272/. Date Accessed August 13, 2026.