The peroneus brevis inserts on the fifth metatarsal styloid process as the primary ankle evertor. In the retromalleolar groove it runs anterior to the peroneus longus — the brevis is closest to the fibula and most vulnerable to longitudinal split tears from the sharp posterior fibular edge or a low-lying peroneus brevis muscle belly. Longitudinal split tears of the PB are the most common peroneal tendon pathology.
Primary ankle evertor; the primary dynamic lateral ankle stabiliser; the first peroneal tendon encountered on the lateral malleolus surface
Peroneus brevis longitudinal split tears from retromalleolar groove injury produce persistent lateral ankle pain after sprain that fails to resolve. MRI shows the C-shaped or fragmented brevis tendon on axial cuts at the fibular level. Surgical options: tubularisation for small splits, excision and tenodesis to longus for large irreparable tears. Superior peroneal retinaculum repair addresses the groove instability contributing to the tear.
Retromalleolar groove PB tendon split from acute or chronic injury producing lateral ankle pain managed with tubularisation or longus tenodesis.
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