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.
| Muscle | |
|---|---|
| Attachment | Passes posterior to the lateral malleolus behind the brevis, descends along the lateral calcaneus to the cuboid groove, crosses the plantar foot to insert on the medial cuneiform and first metatarsal base plantar surface |
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, where the longus lies behind the brevis in a shared sheath and is often injured alongside brevis split tears, and at the cuboid tunnel (isolated longus pathology). MRI distinguishes tenosynovitis (fluid in the sheath), longitudinal split tears and complete tears. Isolated longus tears at the cuboid tunnel produce lateral midfoot pain during push-off. Repair or tenodesis to the brevis is the surgical option for symptomatic tears, combined with superior peroneal retinaculum repair if the tendons are unstable.
Isolated longus tendon disruption at the plantar cuboid groove producing lateral midfoot pain managed with surgical repair or tenodesis.
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