The peroneal retromalleolar bursa lies between the peroneal tendons and the posterior surface of the lateral malleolus in the retromalleolar groove. It reduces friction as the peroneal tendons course around the tip of the lateral malleolus. It is distinct from the lateral malleolus bursa (subcutaneous) and the peroneal tendon sheaths themselves.
Peroneal retromalleolar bursal inflammation produces posterior to the lateral malleolus pain, swelling, and tenderness over the peroneal tendon groove. It may accompany peroneal tenosynovitis, peroneal tendon tear, or superior peroneal retinaculum injury. Ultrasound differentiates bursitis from tendon tear by demonstrating an echo-free fluid collection separate from the tendon sheath. Treatment is anti-inflammatory therapy, corticosteroid injection into the bursa with ultrasound guidance, and orthotic support. In persistent cases, retromalleolar groove deepening surgery addresses the underlying bony anatomy.
Lateral ankle sprain injuring the superior peroneal retinaculum produces concurrent retromalleolar bursitis with swelling and point tenderness posterior to the lateral malleolus; distinguished from peroneal tendon tear by ultrasound showing intact tendons and isolated bursal fluid collection managed by injection.
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