The peroneus brevis tendon inserts at the styloid process (tuberosity) at the base of the fifth metatarsal. The distal peroneus brevis tendon wraps around the posterior lateral malleolus and beneath the superior peroneal retinaculum before inserting at the styloid. The tuberosity is the attachment point subject to avulsion fracture in ankle inversion and the site of longitudinal splitting of the peroneus brevis in the retromalleolar groove.
| Muscle | |
|---|---|
| Attachment | Tuberosity at the base of the fifth metatarsal |
Everts the foot and assists plantarflexion
The peroneus brevis insertion at the fifth metatarsal styloid is the site of zone 1 avulsion fractures (the most common fifth metatarsal fracture) from acute ankle inversion. Treatment is conservative (weight-bearing as tolerated) as the fracture typically heals, unlike the true Jones fracture further distal at the metaphyseal-diaphyseal junction. Proximally, the tendon flattens as it passes against the fibula in the retromalleolar groove and can develop longitudinal split tears, seen as a C-shaped or split tendon on axial MRI. These are managed by debridement and tubularisation repair, often with superior peroneal retinaculum repair.
Sudden ankle inversion with peroneus brevis contraction avulses the fifth metatarsal styloid at zone 1, producing lateral foot pain and a transversely oriented fracture at the tuberosity base on radiograph; treatment is symptomatic weight-bearing as tolerated as zone 1 fractures consistently heal with conservative management unlike the high non-union risk of zone 2 Jones fractures.
Longitudinal splitting of the tendon from repeated compression against the fibular groove, producing lateral ankle pain and swelling, confirmed on axial MRI and managed by debridement and repair.
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