3 - Lateral and Medial Ankle: peroneal and Posterior Tibialis Tendon Injury Overview: pathology and Treatment

The lecture provides an overview of peroneal and posterior tibial tendon pathology, both underdiagnosed causes of lateral and medial ankle pain, respectively, and associated evidence-based treatments and rehabilitation approaches.   Peroneal (brevis/longus) and posterior tibial tendon injury may be acute or chronic, with partial or full tear.   A targeted patient history, physical exam and use of x-ray, ultrasound, and magnetic resonance imaging (MRI) help verify suspected tendon pathology.  Nonoperative management includes immobilization, bracing, nonsteroidal anti-inflammatory drugs (NSAIDs), heel wedges, physical therapy, and injections, at least some of which are traditionally attempted prior to considering surgical approaches that include tendon debridement, tenosynovectomy, tendon tubularization, tendon grafting, or tenodesis.  Associated co-morbid pathologies include tendon subluxation, bony defects, valgus/varus deformity, and ankle instability.