Tendon Disorders >
Surgical Tendon Repair
Surgery typically is prescribed to treat tears
in your peroneal tendon. Your surgeon also can repair
the tissues that hold your peroneal tendons in the tunnel
behind the outside of your anklebone (lateral malleolus).
If you continue to have ankle pain after four to six
weeks of conservative treatment, you may become a candidate
for surgery to treat your peroneal tendon disorder.
Repairing your peroneal tendons usually requires open
surgery, but many patients leave on the same day after
Preparing for Surgery
If you and your physician have decided on surgery to
treat your peroneal tendon disorder, the decisions you
make and the actions you take before your surgery can
be every bit as important as the procedure itself in
ensuring a healthy recovery.
to your return home from the hospital, make sure that
you have received any equipment you will need when you
get home. This may include crutches or household items
to make movement around the house easier. You should
receive prescriptions for any of these from your doctor
before you go home from the hospital.
physical problems or changes in your overall health,
such as a fever or infection, should be reported to
your surgeon, and you should notify your surgeon of
any new medications you are taking.
the potential risks and benefits of the surgery by asking
your surgeon any questions that will help you better
understand the procedure. It can also help to talk to
someone else who has undergone the same surgery.
possible, practice walking with your crutches so you
are ready to use them after surgery.
a second opinion from another qualified surgeon is often
advisable, particularly in rare or unique cases.
check if the orthopedist performing the surgery is board-certified
or eligible, call the American Board of Orthopaedic
Surgery at 919-929-7103.
At most medical centers, you will go to "patient
admissions" to check in for your operation. There
may be separate check-in areas for ambulatory outpatient
(patients go home the same day after surgery) and for
overnight inpatient surgery, so be sure to ask your
doctor or one of his assistants about this. After you
have checked in to the hospital, you will go to a holding
area where the final preparations are made. The mandatory
paperwork is completed, and your ankle may be shaved,
though this is not always necessary. You will be asked
to change into a hospital gown and, if applicable, remove
your watch, glasses, dentures, and jewelry. You will
have the opportunity to speak with your orthopedic surgeon
or one of his assistants and meet the anesthesiologist
or nurse anesthetist (a nurse who has done graduate
training to provide anesthesia under the supervision
of an anesthesiologist). An IV (intravenous) line may
be inserted into your arm at this time. You will then
walk or ride on a stretcher to the operating room. Most
patients are not sedated until they go into the operating
room. Here are some important things to remember for
the day of your surgery:
will probably be told not to eat or drink anything after
midnight on the night before your surgery. This will
reduce the risk of vomiting while you are under general
or regional anesthesia.
you will most likely be able to go home within a few
hours of surgery, arrange for someone to drive you home
when you are released.
a loose pair of shorts, sweatpants, or other clothing
that will fit comfortably over your short leg cast or
splint when you leave the hospital.
it easy. Keeping a good frame of mind can help ease
any nerves or anxiety about undergoing surgery. Distractions
such as reading, watching television, chatting with
visitors, or talking on the telephone can also help.
Surgically repairing your peroneal tendons usually takes
1-1 1/2 hours to perform. Spinal anesthesia is given
to numb you from the waist down, and you are sedated
so that you sleep through the procedure.
incision approximately 12 centimeters long is made along
the outside of your ankle, along your peroneal tendons.
open up the sheath surrounding your peroneal tendons
and inspect the tendons for any longitudinal tears.
less than 50 percent of the tendon has tears running
through it, the tendon tissue usually can be sewn back
together with sutures.
more than 50 percent of the tendon is torn or frayed,
then your surgeon generally performs a procedure called
tenodesis. The damaged portion of your tendon is cut
away and the remaining portion is sutured to the other
peroneal tendon next to it. Because the peroneus brevis
is more commonly torn, the most common tenodesis procedure
for peroneal tendon disorders involves sewing the end
of the peroneus brevis to the intact peroneus longus.
some cases when your tendon has dislocated, the tissue
that typically holds your peroneal tendons in the tunnel
behind your small lower leg bone is loose. Suturing
this tissue, called retinaculum, back to itself can
tighten the tendon tunnel. A tighter tunnel helps prevent
future tendon dislocations.
tendon sheath and skin incisions are closed with stitches
and your ankle is put into a splint to immobilize it.
You are then taken to the recovery room.
After surgical repair of your peroneal tendon disorder,
you will be transported to the recovery room, where
you will be closely observed for one to two hours while
the immediate effects of anesthesia wear off. Your ankle
will be immobilized in a splint when you wake up, and
your ankle will be elevated. After surgery, you will
experience some pain. Adequate pain medications will
be prescribed for you. You may be given intravenous
(IV), oral, or intramuscular pain medications as needed.
Your surgeon will prescribe crutches, and you are usually
instructed to keep all weight off your ankle for the
first few weeks. Your temperature, blood pressure, and
heartbeat will be monitored by a nurse who, with the
help of the doctor, will determine when you can prepare
to go home. You normally leave the hospital or clinic
the same day after surgery, sometimes within four hours.
If you experience a lot of pain, you may be admitted
for an overnight stay after surgical repair of your
peroneal tendons. Make sure to have someone available
to drive you home, as you will be unable to drive a
After surgical repair of your peroneal tendon, you
may need to be on crutches for about six weeks. Rest
as much as possible with your ankle elevated above the
level of your heart. This helps blood drain away from
your ankle and controls swelling. It is essential to
keep as much weight as possible off your ankle. The
more weight you put on your ankle, the greater your
chances of further damaging the tendon. Household tasks
that require you to be on your feet may be difficult
for six to eight weeks. It can be helpful to have someone
around the house who can help with any physical chores.
You will most likely return to your physician’s
office within 10 to 14 days to have your sutures taken
out and the post-surgery ankle splint replaced by either
a short leg cast or a splint called a cam walker.
To keep the cast dry, wrap a plastic garbage bag around
the cast while showering, or bathe with your leg out
of the tub. You usually can bear some weight while wearing
the cast or cam walker for about six to eight weeks.
Typically, you will return to your physician for check-up
visits every two weeks until your tendon has healed.
If your ankle was immobilized in a cast, your ankle
may be put into a removable cam walker when the cast
is removed. In general, you should continue using your
crutches and wearing your cam walker as instructed by
your doctor until symptoms resolve. Many patients, especially
those who had extensive tendon damage, begin weight
bearing in a cam walker for an additional three to four
weeks. As you go back to normal shoe wear, sometime
between eight and 12 weeks after surgery, you may need
to wear an air cast in your shoe to help support your
ankle. Your physician may suggest physical therapy that
can be done at home, or refer you to a physical therapist
when your cast comes off.
Recovery from surgical repair of your peroneal tendon
typically takes about four months. Your ankle will feel
weak when it comes out of the cast and it is important
to perform gentle range of motion exercises three or
four times a day for three or four weeks after your
cast is removed. Physical therapy to strengthen your
ankle generally is prescribed sometime after eight to
12 weeks, when your physician has put your ankle into
an air cast or you can bear your own weight without
much discomfort. If you experience episodes of pain
or discomfort while exercising, have your physician
examine your ankle. By following a physical therapist’s
routine, many patients can return to sports and activities
within six months. Physical therapy usually involves
learning an ankle stretching routine and performing
ankle and lower leg strengthening exercises.
To prevent reinjury to your ankle, you should strengthen
your peroneal tendons. Physicians often recommend proprioceptive
training, which includes training with a special balance
board (BAPS board) that rolls on top of a ball. Increasing
your ankle strength and balance can help you better
withstand strain on your ankle during activities. The
peroneal tendons prevent inward turning of your ankle
(inversion) and are responsible for the stability of
your ankle. It is difficult to know who may be prone
to future peroneal tendon injuries, but people with
weak tendons may have a tendency to invert their ankle
and suffer an ankle sprain or reinjure their peroneal
tendons. Though you usually do not have any restrictions
on your activities after surgery, you should be cautious
when running on uneven surfaces or engaging in high-velocity
sports that may cause twists or falls.