The peroneal tendons pass through the retromalleolar groove in a shared synovial sheath, stabilised by the superior peroneal retinaculum. The peroneus longus lies posterolateral to the peroneus brevis in the groove. Peroneal tendon tears most commonly occur at the retromalleolar level — the brevis develops longitudinal split tears from chronic impingement against the fibula, while the longus tears more distally at the cuboid groove.
The retromalleolar groove is the critical inflection point where the peroneus longus changes direction from the posterior leg to the lateral and plantar foot — maximum tendon stress occurs here
Peroneal tendon pathology at the retromalleolar groove: MRI differentiates tenosynovitis (fluid in the sheath), longitudinal split tear of the brevis (semilunar shape on cross-section), and complete tear. Peroneal tendon subluxation from SPR tear produces a painful snap over the fibula during ankle eversion. SPR repair restores groove integrity.
Retromalleolar groove fibular impingement producing a split tear in the peroneus brevis managed with tendon debridement, tubularisation, and SPR repair.
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