The peroneal tendons, the combined peroneus longus and brevis, travel together in a shared sheath through the retromalleolar groove behind the lateral malleolus, held in place by the superior peroneal retinaculum, with the brevis lying against the bone and the longus behind it. The malleolus acts as a pulley redirecting their pull into the foot. They are the primary dynamic stabilisers of the lateral ankle against inversion forces and are susceptible to tendinopathy, brevis split tears, and retinacular disruption allowing the tendons to sublux anteriorly over the lateral malleolus.
| Muscle |
|
|---|---|
| Attachment | First metatarsal base and medial cuneiform (longus), fifth metatarsal styloid (brevis) |
Foot eversion; lateral ankle stability; push-off assistance
Peroneal tendon subluxation produces a painful snap or click at the lateral ankle as the tendons escape anteriorly over the lateral malleolus during foot movement. It is often misdiagnosed as an ankle sprain because it frequently accompanies lateral ligament injuries. The mechanism of injury is forced dorsiflexion with peroneal contraction, rather than the typical inversion of an ankle sprain, and a shallow or convex retromalleolar groove predisposes to it. Superior peroneal retinaculum repair, often combined with groove deepening, is required for recurrent symptomatic subluxation.
Anterior displacement of the peroneal tendons over the lateral malleolus from superior peroneal retinaculum disruption, producing a lateral ankle snap with eversion that requires surgical retinaculum repair for recurrent cases.
Overuse degeneration behind the lateral malleolus producing posterior lateral ankle pain worsened by running and eversion activities, managed with load modification, orthotics, and eccentric strengthening.
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