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Question for Dr. Z re: peroneal longus tendon

Posted by Rebecca on 5/13/01 at 22:23 (047681)

I posted a question about this pain in the lateral bottom of my foot that you responded to suggesting that it might have something to do with peroneal longus tendon. Do you mean like a tear or injury or irritation of some kind? What can be done to help this? How is it diagnosed? Thanks so much for your time!

Re: Question for Dr. Z re: peroneal longus tendon

bg cped on 5/14/01 at 06:57 (047695)

Rebecca I posted to you under the products treatment thread regarding your shoes and fo. It is towards the bottom

Re: Question for Dr. Z re: peroneal longus tendon

Dr. Zuckerman on 5/14/01 at 10:38 (047708)

Usually it isn't torn but due to the type of foot that you have will malfunction and cause pain on the bottom on the foot. It goes with the Cavus type of foot structure.

Re: Question for Dr. Z re: peroneal longus tendon

Rebecca on 5/14/01 at 11:05 (047714)

Thanks, I replied to you there, also.

Re: Question for Dr. Z re: peroneal longus tendon

Dr. David S. Wander on 5/14/01 at 16:18 (047734)

Although a tear of the peroneus longus tendon is rare, it can and does occur. Injury to the peroneus longus or peroneus brevis tendon is often overlooked during ankle sprains and injuries. It is rare to rupture these tendons without some preceding trauma, although it can occur if the tendon was weakened from chronic inflammation, steroid injections, etc. A physical examination is very important while testing the integrity of these tendons, and an MRI can confirm any tear or partial tear. If you are more specific regarding the symptoms and history of the problem, I may be able to give you my opinion regarding possible causes. In 1994 I published an article in the JOURNAL OF FOOT & ANKLE SURGERY, titled 'Surgical Management of a Ruptured Peroneus Longus Tendon With a Fractured Multipartite Os Peroneum' so I'm very familiar with these rare injuries and the symtoms and causes. Fill me in on the details and I'll see if I can help.

Re: Question for Dr. Z re: peroneal longus tendon

bg cped on 5/14/01 at 17:54 (047740)

Dr Wander that paper sounds interesting, is it available online anywhere? You noted previous trauma and ster inj as a possible cause for peroneal injury. Did you find more cavus or pronated feet to be involved? Do you think it is possible to have a cavus foot with an over posted, high arch orthotic cause damage to peroneal. Or do you think that foot function is not a real factor but more related to outside trauma, injections, etc.

Sorry for the laundry list I just like to learn as much as possible

Re: Question for Dr. Z re: peroneal longus tendon

Dr. David S. Wander on 5/14/01 at 21:30 (047751)

I have not found foot type to have been a major factor in the peroneus injuries that I have treated. However, a cavus foot is prone to more lateral column strain, therefore it would seem intuitive that the peroneal tendons are more vulnerable to injury. The vector of pull of the peroneus longus tendon changes significantly in a pronated foot, but I haven't related this to a higher incidence of peroneal tears. Foot type can cause pathology or symptoms, without causing a tear. A prime example would be a patient with a severely pronated foot with posterior tibial dysfunction. Although the Posterior tibial tendon may not be torn, it may be attenuated ('stretched out') due to the mechanics of the foot. This can also occur with the peroneal tendons, with injury or chronic pain as a result of foot type and foot function. However, the peroneal tears that I've treated to date, have all been trauma related. Additional causes of tendon injury can be a degenerative process secondary to arthritis, rheumatoid synovitis or previous infection.

Re: Question for Dr. Z re: peroneal longus tendon

bg cped on 5/14/01 at 22:28 (047752)

Thanks for your timely response. I just thought it may be more than a coincidence that I have seen probably 4 pt in the last 2 month with peroneal issues and all had some degree of cavus foot. Two were caused or aggravated by excessive, incorrect varus posting of their orthotics. It would be interesting to see the ratio of pronate vs supinate pt with peroneal problems that were non traumatic.
The cases that had a past history of inversion instabilty would most likely present with subtle or not so subtle cavus deformity would they not? Please share your thoughts. Also Dr Z and Dr Ried I would appreciate your imput as well

Re: Question for Dr. Z re: peroneal longus tendon

bg cped on 5/15/01 at 10:44 (047799)

did a search on pub med and found this, it is interesting. Let me know what your thoughts are, I didnt read the complete paper

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10884103&dopt=Abstract

Re: Response to Dr. Wander re: peroneal longus tendon

Rebecca on 5/15/01 at 14:52 (047825)

Dr. Wander, To be more specific: I have a point of tenderness on the bottom of my midfoot just in from the knobby bone (first metatarsal?) on the lateral side and then pain radiating from there, including stiffness and pain in the lateral side of my ankle. The pain follows the same typical pattern as pf; really bad when I get out of bed and first-steps pain after sitting or resting that gets worse later in the evening and by activities like going to Costco or walking alot during the day. This started after I ran about a 1/4 mile down the street in casual shoes to get out of a hail storm. I had a lot of ankle pain immediatley following running a marathon a few years ago and had xrays but nothing was found to be wrong. I've also had pf in the same foot for almost three years. Thanks.

Re: Response to Dr. Wander I thought of something else

Rebecca on 5/15/01 at 15:14 (047828)

Dr. Wander, to add to my post above, I have very high arches and have had five cortizone injections for the pf and that foot.

Re: Question for Dr. Z re: peroneal longus tendon

Dr. David S. Wander on 5/15/01 at 21:50 (047880)

I read the article you're referring to, and it is very interesting. As I stated in a prior posting, the cavus foot does place a lot of stress on the lateral column and therefore can cause pathology of the peroneal tendons and/or lateral ankle ligaments.

Re: Question for Dr. Z re: peroneal longus tendon

bg cped on 5/15/01 at 22:30 (047882)

Is the paper only available online thru pubmed? I assume you have to purchase it from them, I never have done that. Also do you have your paper available online? Thanks for the response

Re: Question for Dr. Z re: peroneal longus tendon

bg cped on 5/14/01 at 06:57 (047695)

Rebecca I posted to you under the products treatment thread regarding your shoes and fo. It is towards the bottom

Re: Question for Dr. Z re: peroneal longus tendon

Dr. Zuckerman on 5/14/01 at 10:38 (047708)

Usually it isn't torn but due to the type of foot that you have will malfunction and cause pain on the bottom on the foot. It goes with the Cavus type of foot structure.

Re: Question for Dr. Z re: peroneal longus tendon

Rebecca on 5/14/01 at 11:05 (047714)

Thanks, I replied to you there, also.

Re: Question for Dr. Z re: peroneal longus tendon

Dr. David S. Wander on 5/14/01 at 16:18 (047734)

Although a tear of the peroneus longus tendon is rare, it can and does occur. Injury to the peroneus longus or peroneus brevis tendon is often overlooked during ankle sprains and injuries. It is rare to rupture these tendons without some preceding trauma, although it can occur if the tendon was weakened from chronic inflammation, steroid injections, etc. A physical examination is very important while testing the integrity of these tendons, and an MRI can confirm any tear or partial tear. If you are more specific regarding the symptoms and history of the problem, I may be able to give you my opinion regarding possible causes. In 1994 I published an article in the JOURNAL OF FOOT & ANKLE SURGERY, titled 'Surgical Management of a Ruptured Peroneus Longus Tendon With a Fractured Multipartite Os Peroneum' so I'm very familiar with these rare injuries and the symtoms and causes. Fill me in on the details and I'll see if I can help.

Re: Question for Dr. Z re: peroneal longus tendon

bg cped on 5/14/01 at 17:54 (047740)

Dr Wander that paper sounds interesting, is it available online anywhere? You noted previous trauma and ster inj as a possible cause for peroneal injury. Did you find more cavus or pronated feet to be involved? Do you think it is possible to have a cavus foot with an over posted, high arch orthotic cause damage to peroneal. Or do you think that foot function is not a real factor but more related to outside trauma, injections, etc.

Sorry for the laundry list I just like to learn as much as possible

Re: Question for Dr. Z re: peroneal longus tendon

Dr. David S. Wander on 5/14/01 at 21:30 (047751)

I have not found foot type to have been a major factor in the peroneus injuries that I have treated. However, a cavus foot is prone to more lateral column strain, therefore it would seem intuitive that the peroneal tendons are more vulnerable to injury. The vector of pull of the peroneus longus tendon changes significantly in a pronated foot, but I haven't related this to a higher incidence of peroneal tears. Foot type can cause pathology or symptoms, without causing a tear. A prime example would be a patient with a severely pronated foot with posterior tibial dysfunction. Although the Posterior tibial tendon may not be torn, it may be attenuated ('stretched out') due to the mechanics of the foot. This can also occur with the peroneal tendons, with injury or chronic pain as a result of foot type and foot function. However, the peroneal tears that I've treated to date, have all been trauma related. Additional causes of tendon injury can be a degenerative process secondary to arthritis, rheumatoid synovitis or previous infection.

Re: Question for Dr. Z re: peroneal longus tendon

bg cped on 5/14/01 at 22:28 (047752)

Thanks for your timely response. I just thought it may be more than a coincidence that I have seen probably 4 pt in the last 2 month with peroneal issues and all had some degree of cavus foot. Two were caused or aggravated by excessive, incorrect varus posting of their orthotics. It would be interesting to see the ratio of pronate vs supinate pt with peroneal problems that were non traumatic.
The cases that had a past history of inversion instabilty would most likely present with subtle or not so subtle cavus deformity would they not? Please share your thoughts. Also Dr Z and Dr Ried I would appreciate your imput as well

Re: Question for Dr. Z re: peroneal longus tendon

bg cped on 5/15/01 at 10:44 (047799)

did a search on pub med and found this, it is interesting. Let me know what your thoughts are, I didnt read the complete paper

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10884103&dopt=Abstract

Re: Response to Dr. Wander re: peroneal longus tendon

Rebecca on 5/15/01 at 14:52 (047825)

Dr. Wander, To be more specific: I have a point of tenderness on the bottom of my midfoot just in from the knobby bone (first metatarsal?) on the lateral side and then pain radiating from there, including stiffness and pain in the lateral side of my ankle. The pain follows the same typical pattern as pf; really bad when I get out of bed and first-steps pain after sitting or resting that gets worse later in the evening and by activities like going to Costco or walking alot during the day. This started after I ran about a 1/4 mile down the street in casual shoes to get out of a hail storm. I had a lot of ankle pain immediatley following running a marathon a few years ago and had xrays but nothing was found to be wrong. I've also had pf in the same foot for almost three years. Thanks.

Re: Response to Dr. Wander I thought of something else

Rebecca on 5/15/01 at 15:14 (047828)

Dr. Wander, to add to my post above, I have very high arches and have had five cortizone injections for the pf and that foot.

Re: Question for Dr. Z re: peroneal longus tendon

Dr. David S. Wander on 5/15/01 at 21:50 (047880)

I read the article you're referring to, and it is very interesting. As I stated in a prior posting, the cavus foot does place a lot of stress on the lateral column and therefore can cause pathology of the peroneal tendons and/or lateral ankle ligaments.

Re: Question for Dr. Z re: peroneal longus tendon

bg cped on 5/15/01 at 22:30 (047882)

Is the paper only available online thru pubmed? I assume you have to purchase it from them, I never have done that. Also do you have your paper available online? Thanks for the response