The peroneus longus tendon has two distinct sections, a posterior section behind the lateral malleolus and a plantar section that turns sharply around the cuboid and crosses the sole obliquely to insert on the medial cuneiform and first metatarsal base. In the sole it runs in the groove on the plantar cuboid, in a fibro-osseous tunnel roofed by the long plantar ligament, which lets it plantarflex the first ray and support the arches. The plantar course is a specific site of peroneus longus tears distinct from the more common peroneus brevis tears at the fibular groove, producing lateral plantar foot pain rather than lateral malleolar pain.
| Muscle | |
|---|---|
| Attachment | Enters the cuboid groove on the plantar foot from the lateral ankle, crosses the plantar foot obliquely to the medial cuneiform and first metatarsal base |
First ray plantarflexion and medial arch support through the plantar course
Peroneus longus tears or tenosynovitis at the cuboid notch produce chronic lateral plantar midfoot pain exacerbated by push-off activities. MRI and ultrasound identify the tear in the plantar tendon course and distinguish it from retromalleolar pathology. The os peroneum, a sesamoid in the tendon at the cuboid, is present in roughly a fifth to a quarter of people. Fracture or diastasis of the os peroneum, or a painful os peroneum syndrome, indicates significant peroneus longus injury at this level.
Tendon disruption in the plantar cuboid groove producing lateral plantar foot pain distinct from ankle-level peroneal pathology, confirmed by MRI and managed with orthotics or surgical repair.
Fracture, diastasis or irritation of the os peroneum after an inversion injury or overuse, producing point tenderness at the cuboid groove, diagnosed with radiographs and MRI.
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