Peroneal Longus and Brevis Tendons

Sonography is an effective method for diagnosing tears of the peroneal tendons as well as peroneal tendon subluxation [60]. It can also distinguish normal tendon from tendon tears caused by other conditions such as tendinopathy and tenosynovitis (Figs. 24, 25). Dynamic ultrasound is very useful in diagnosing peroneal tendon dislocation with ankle motion (Fig. 26).

Peroneal tendon tears are most commonly longitudinal, partial-thickness tears (Fig. 27) [59]. Sonography has a high sensitivity, specificity, and accuracy for the diagnosis of peroneal tendon tears: 100%, 85%, and 90%, respectively [59]. This accuracy is comparable to that achieved using MRI [61-63]. It should be remembered that sonography is operator-dependent, and that the accuracy of diagnosis of peroneal tendon tears is most likely greatest when the test is interactive. The authors agree with the published recommendation that sonogra-phy should be the first imaging test for the diagnosis of a clinically suspected peroneal tendon tear [59].

Anterolateral Stress Fracture
Fig. 21. Posterior tibialis tendinopathy. Transverse sonographic images of the posterior tibialis tendon demonstrate a hypoechoic tendon (arrow) (A) without a tear. Color Doppler image (B) shows hypervascularity surrounding the tendon representing tenosynovitis.
Tibialis Post
Fig. 22. Tibialis posterior tenosynovitis. Longitudinal images of the distal posterior tibialis tendon (arrows) show a normal tendon (A) with fluid circumferentially surrounding the tendon (notched arroW) with hypervascularity (B) representing tenosynovitis.

Peroneal subluxation usually involves one or both peroneal tendons moving anterolateral^ over the lateral malleolus. Peroneal tendon subluxation can be demonstrated using real-time dynamic sonography (see Fig. 26). Dynamic sonographic evaluation in the transverse plane while actively inverting and everting the foot can demonstrate transient peroneal subluxation, if present, as well as evaluate the depth of the peroneal groove [54]. The positive predictive value of dynamic sonography for peroneal tendon subluxation is 100% [60]. Both CT and MRI are useful for detecting obvious subluxed or dislocated peroneal tendons by revealing the position of the tendons relative to the fibular groove; however, neither of these static imaging techniques can reveal transient subluxation or dislocation (see Fig. 27).

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