Peroneal tendon surgery is considered effective with a low risk of serious side effects if recommended by a doctor for those who are generally healthy.

Peroneal tendon surgery is a procedure to repair one of the tendons of your peroneal muscles, also called your fibularis muscles. A tendon is a piece of connective tissue that connects a muscle to bone.

Your peroneal muscles are found on the outer side of your lower leg. They help move and stabilize your ankle. Your three peroneal muscles all insert into the outer side of your foot, but they each originate from a different part of your leg:

  • Peroneus Longus connects to the top of your fibula just below your knee.
  • Peroneus Brevis connects to the middle of your fibula.
  • Peroneus Tertius connect to your lower fibula just above your ankle.

Your peroneal tendons may get damaged from sudden injuries or repetitive stress. Runners and other athletes who experience repetitive ankle movement are at particular risk of injury.

Read on to learn more about peroneal tendon surgery, including the risks, success rates, and recovery time.

Surgery can potentially be a highly effective treatment option for peroneal tendon injuries that have not improved or healed with more conservative treatment.

For example, in a 2016 study, researchers found that 83.1% of people in a group of 201 people who underwent peroneus brevis tendon repair from 2008 to 2012 returned to regular exercise and sport at a 1-year follow-up.

Surgeons use many different surgical techniques to treat peroneal injuries. Some of these techniques include:

  • Tendon debridement and synovectomy: Your surgeon makes an incision in your ankle so that they can clear away degenerated and inflamed tissues as well as the damaged membrane of the tendon. It may be used to treat tendonitis.
  • Tendon debridement and tubularization: The injured part of your tendon is removed and repaired with sutures. You may receive this type of surgery to repair a partially torn tendon.
  • Arthroscopic peroneal tendoscopy: A long tube with a camera is inserted into your tendon sheath. Special tools are used to clear away damaged tissue. Most studies report good to excellent results with few complications.
  • Endoscopic retinaculum repair: The band of tissue that holds your peroneal tendons in place can become damaged if the tendons move from their usual location. This tissue may need to be repaired surgically with an endoscopic procedure. An endoscope is a long thin tube with a camera and special tools.
  • Allograft or autograft reconstruction: An autograft involves repairing your tendon with connective tissue from another part of your body. An allograft repairs it with tissue from a donor.

Peroneal tendon surgeries are generally safe with a low risk of complications. In a 2022 review, researchers reported a complication rate of 38.7% among 336 people who underwent 5 types of surgery for their peroneal tendons.

The most common complication is skin numbness from damage to branches of your sural nerves.

Other complications can include:

  • injury to nerves, arteries, or veins
  • scarring
  • swelling
  • bleeding
  • recurrent tears
  • delayed wound healing
  • degeneration of tendon
  • loss of range of motion
  • infection
  • pain

A good candidate for surgery is somebody who has a peroneal tendon injury that hasn’t responded to conservative treatment options and who is in good enough overall health to undergo surgery. Doctors usually recommend trying conservative treatment options for at least 4 to 8 weeks before undergoing surgery, though some doctors may recommend longer.

Peroneal tendon surgery might be needed for a peroneal tendon injury that doesn’t respond to other conservative options. The most common group with peroneal tendon injuries are young and active people, especially athletes in sports with repetitive impact on the ankle like runners.

Some conditions that may require surgical repair include:

  • Peroneal tendonitis: Peroneal tendonitis is inflammation in one of your peroneal tendons caused by a sudden injury or repetitive stress.
  • Peroneal subluxation: Peroneal subluxation occurs when one or more of your tendons slip out of their usual position.
  • Peroneal tendon tear: A tear in your peroneal tendon can range from microscopic to a complete rupture. The majority of tears are from chronic stress.

The peroneal muscles help stabilize your ankle. Leaving a peroneal tendon injury untreated may contribute to ankle instability and an increased risk of ankle sprains.

Undergoing treatment as soon as possible can help prevent the progression of the injury to more complex injuries like complete tendon tears.

Most mild or moderate peroneal tendon injuries heal on their own without surgery. Your doctor can help you decide if you need surgery based on factors such as your:

  • injury severity and type
  • symptom duration
  • activity levels

Peroneal tendon surgery is usually reserved for cases where more conservative treatment options have failed. Your doctor may recommend conservative options like the following for at least 4 to 8 weeks, and sometimes longer.

  • physiotherapy
  • bracing
  • anti-inflammatory medications
  • avoiding painful activities or activities that have a risk of reinjury
  • strengthening
  • weight loss

Following the PRICE method may help you speed up your recovery. This acronym stands for:

  • Protection
  • Rest
  • Ice
  • Compression
  • Elevation

Most doctors recommend avoiding weight-bearing activities for between 2 to 6 weeks after surgery depending on the extent of your procedure. There seems to be a current trend to start early range of motion and rehabilitation exercises within 4 weeks. Return to sport is usually allowed after 4 to 6 months.

In a 2016 review of studies, researchers proposed the following protocol after peroneal tendon repair:

0–2no weight-bearing
2–8partial weight-bearing and rehabilitation
8–12full weight-bearing and rehabilitation

Make sure to follow your surgeon’s recommendations for recovery.

Your peroneal tendons can get injured due to a sudden injury or from repetitive stress on your ankle. Your doctor may recommend surgery if conservative treatment options don’t offer you pain relief.

Surgery can be highly effective at treating your injury with a fairly low risk of side effects. The type of surgery you need depends on the type of injury you have.