The peroneus brevis tendon inserts onto the lateral base (styloid) of the fifth metatarsal via a broad insertion. The tendon is round in the retromalleolar groove and flattens as it approaches the styloid insertion, a morphological change that predisposes to longitudinal split tears.
The peroneus brevis distal tendon is the structure attached at the fifth metatarsal styloid — the avulsion site in the common inversion sprain (Jones fracture confusion). True Jones fractures occur 1.5 cm distal to the styloid at the fourth-fifth metatarsal junction, while avulsion fractures involve the actual styloid at the peroneus brevis attachment. The distal tendon longitudinal split tear produces a C-shape on axial MRI at the retromalleolar groove.
Longitudinal splitting of the peroneus brevis distal tendon from repeated compression against the fibular groove producing lateral ankle pain with running, confirmed by axial MRI and managed by debridement and tubularisation repair.
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