Fibular tendons pathologies

Definition

Fibular tendon problems can be divided into three categories, which may be interrelated:

  • Fibular tendinosis
  • Fibular tendon tears with or without rupture
  • Fibular tendon subluxation or dislocation.


Symptoms
Pain in the postero-lateral aspect of the ankle, backwards to the lateral malleolus,  is the main presenting complaint.
Recurrent swelling , repeated so-called  giving-way are often reported.


Causes
Chronic ankle instability or a hindfoot varus deformity, or both, predisposes the patient to fibular tendon pathology.
Congenital disorders, such as , supernumerary tendons, insufficient depth of the fibular groove are pointed out.


Diagnosis
Plain X-rays in eight bearing, stress views MRI to assess the tendons disorders.
Dynamic Ultrasonography if subluxation or recurrent dislocation of the tendons.


Medical treatment

  • Local and oral anti-inflammatory drugs
  • Physiotherapy, proprioception rehabilitation
  • Orthotics with correction of the varus deformity by a pronative band


Surgical treatment

  • For the tendons themselves :

o   For tendinosis tenoscopy  with debridement
o   Open surgery with debridement, repair of the tears, tenodesis if rupture  with severe damages
o   For dislocation of the tendons, retinaculum repair with augmentation, deepening of the fibular groove, resection of any muscle abnormality

  • For correlated lesions :

o   Surgery of a chronic ankle laxity
o   Calcaneus osteotomy for hindfoot varus deformity