The peroneal tubercle (peroneal trochlea) is a small bony projection on the lateral calcaneal surface that serves as a separator between the peroneus longus (which passes inferior to it) and the peroneus brevis (which passes superior to it) as they curve around the lateral calcaneus. The inferior peroneal retinaculum attaches to the peroneal tubercle. Its size varies considerably; a hypertrophied peroneal tubercle can impinge on the peroneal tendons.
A hypertrophied peroneal tubercle causes peroneal tendon impingement syndrome, producing lateral calcaneal pain, peroneal tenosynovitis, and occasionally peroneus longus split tears at the tubercle level. Lateral foot radiograph and MRI identify the enlarged tubercle and associated tendon pathology. Treatment is conservative initially; persistent symptoms are treated by surgical excision of the hypertrophied tubercle with tenosynovectomy. Calcaneal fractures extending to the lateral wall may displace the peroneal tubercle, trapping the peroneal tendons.
An enlarged peroneal tubercle compresses the peroneus longus and brevis tendons as they pass on either side, producing lateral calcaneal pain, tenosynovitis, and longitudinal tendon splits visible on MRI; surgical excision of the tubercle with inspection and repair of any associated tendon tears provides lasting relief.
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