What is the Paroneal Tendon?

• Tendons are tissues in the body that connect muscle and bone to one another. There are actually two peroneal tendons on each foot. They originate in the lower calf in the back of each leg and extend down, pulling sharply forward once they pass beneath the fibula (outer ankle). One connects to the bone near the outside of the midfoot, called the fifth metatarsal. The other curls beneath the foot to attach to the underside of the arch. They function to ensure stability and control of the ankle when weight is put down on the foot, such as when we walk or run. Without them, the ankle would give out when we try to walk and we would fall. Unfortunately, the peroneal tendons undergo a great deal of strain at the point where they pass under the fibula and over time can begin to fray or even break outright. This is known as a longitudinal peroneal tear and requires immediate surgery to repair.
  
  

Preparation

• The patient is prepared for surgery by being administered anti-inflammatory medications. This will keep the tissue around the damaged tendons from swelling and aid the surgeon in completing his work. Light sedation is performed--propofol or sodium thiopental in low doses administered intravenously. This is different from general anesthesia in that general anesthesia is a deeper state of unconsciousness in which machinery is required to keep the patient breathing. The skin surrounding the outer ankle is then sterilized with an iodine solution.
  
  

Surgery

• The surgeon begins by making a roughly three inch long incision which tapers from the back of the heel to just under the protrusion of the outer ankle bone. Using retractors, the surgeon's aid pulls apart the incision to reveal the muscle. Lying atop the muscle is a pink strip, the peroneal retinaculum, a sheath of mucous separating the peroneal tendons from the surrounding muscle. A square incision is cut into the peroneal retinaculum and carefully removed for later, baring the peroneal tendons. The tear should be evident. Healthy, unstressed tendon is a homogenous, shining gray, while damaged tendons look like individual strings and are a bone white. Dissolvable sutures are placed in a pattern known as horizontal mattress stitches. They bind the damaged portion of the tendon and hold it together by placing the constrictive stress on the upper and lower undamaged portions of the tendon. More dissolvable sutures, this time of the standard simple interrupted stitch method, hold the peroneal retinaculum back in place, and then the same happens to the initial incision. The wound is bound and bandaged with sterile gauze and the patient is given strict instructions to keep all weight off the leg in question for at least two weeks after the surgery.