The peroneus longus crosses the plantar foot in the peroneal groove of the cuboid — the only tendon to cross from the lateral to the medial foot plantarly. This unique anatomical course makes it the only muscle that can simultaneously evert the hindfoot and plantarflex the first ray (stabilising the medial arch). Its peroneal groove pathology at the cuboid is a frequently missed cause of lateral midfoot pain.
Ankle eversion and foot plantarflexion; first ray plantarflexion (unique contribution to foot arch via the plantar crossover); medial longitudinal arch support through first ray stabilisation
Peroneus longus tears occur at two distinct locations: at the retromalleolar groove (in association with brevis tears) and at the cuboid tunnel (isolated longus pathology). Isolated longus tears at the cuboid tunnel produce lateral midfoot pain during push-off. MRI in the axial and sagittal planes through the midfoot identifies the tear location. Repair or tenodesis to the brevis is the surgical option for symptomatic tears.
Isolated longus tendon disruption at the plantar cuboid groove producing lateral midfoot pain managed with surgical repair or tenodesis.
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