Peroneus Brevis

Superficial Peroneal Nerve, Common Peroneal Nerve, Sciatic Nerve, Posterior Division Sacral Plexus, L5, SI, S2. 

One handbreadth proximal to the lateral malleolus (LM) and anterior to the peroneus longus (PL) tendon. 

If the electrode is inserted too proximally it will be in the peroneus longus if inserted too anteriorly it will be either in the peroneus ter-tius or in the extensor digitorum longus. 

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In a recent stndy, patients were retrospectively assessed who presented with either a partial or fnfl mptnre of either the peroneus brevis, peroneus longus tendon, or posterior tibial tendon. All mptnres were symptomatic and required surgical repair ranging from complete reattachment to excision of mid-snbstance tears, hi each case, the site of the tendon repair was encircled with the same AM material. 

Initial management should include a trial of anti-inflammatory medication, ankle bracing, and physical therapy. Many diagnostic tests are available. Sobel et al. popularized the peroneal tunnel compression test for longitudinal peroneus brevis tendon tears. This maneuver combines dorsiflexion and eversion of the foot and ankle with manual pressure on the peroneal tendons to elicit a painful response." Plain radiographs may demonstrate bony avulsions of the superior retinaculum or fractures. 

Sammarco GJ, DiRaimondo DV. Chronic peroneus brevis tendon lesions. Foot Ankle 1989 9 163-70. 

Larson E. Longitudinal rupture of the peroneus brevis tendon. J Bone Jt Surg Br 1987 69 340-1. 

Sobel M, Geppert M, Olson E, et al. The dynamics of peroneus brevis tendon splits a proposed mechanism, technique of diagnosis, and classification of injury. Foot Ankle 1992 13(7) 413-22. 

Fig. 4.17. Peroneal subluxation on dynamic ultrasound examination. The peroneus brevis (+) and peroneus longus ( ) are seen to flip over the distal fibula with the foot everted...

Diaz GC, van Holsbeeck M, Jacobson JA (1998) Longitudinal split of the peroneus longus and peroneus brevis tendons with disruption of the superior peroneal retinaculum. J Ultrasound Med 17 525-529... 

These fractures are typically subdivided into three types depending on their location. Zone 1 is the cancellous tuberosity, which includes the insertion of the peroneus brevis and abductor digiti minimi tendons and the lateral cord of the plantar fascia. Zone 2 is the distal aspect of the tuberosity and includes dorsal and plantar ligamentous attachments to the fourth metatarsal. Zone 3 comprises the zone distal to the ligamentous attachments to the mid-diaphyseal area. 

In a degenerative setting, intense muscle contraction or abnormal stress forces exerted on healthy tendons may lead to avulsions at their sites of insertion into bone. These tears often lead to detachment and retraction of a bony fragment which remains embedded in the tendon. Avulsion injuries typically involve the supraspinatus tendon, causing retraction of a fleck of bone from the greater tuberosity, the peroneus brevis, leading to avulsion of the base of the fifth metatarsal, the flexor and extensor digi-... 

Fig. 15.4a,b. Schematic drawings of the lateral compartment of the leg showing the peroneal muscles, a The peroneus longus muscle (PL) takes its origin more cranially and is located superficial to the peroneus brevis (PB). It continues down into the medial aspect of a tendon located posteriorly and then inferiorly to the tendon of the peroneus brevis, b The peroneus brevis muscle arises from the caudal half of the posterolateral aspect of the fibula. Its belly descends down to the lateral malleolus ending on the posterior aspect of the tendon... 

Fig.l6.6a,b. Peroneal tendons, a Photograph of the lateral aspect of the ankle in a girl with her foot plantar flexed and inverted showing the main surface features (arrows) of the peroneals at the distal calf and around the lateral malleolus (LM). b Lateral view of a gross dissection of the ankle illustrates the relationship of the peroneus longus tendon (pi) with the lateral malleolus (LM). Note that the peroneus brevis is not apparent because it is covered by the peroneus longus. A fibrocartilaginous lip (arrowheads) can be appreciated at the site of attachment of the superior peroneal retinaculum onto the lateral malleolus... 

Fig. 16.23 a,b. Normalperoneal tendons, a Short-axis 12-5 MHz US image of the peroneus brevis (pb) and peroneus longus (pi) tendons obtained in the inframalleolar area at the level of the peroneal tubercle (PT) of the calcaneus with b CT correlation. The tubercle is prominent and separates the tendons with the brevis coursing cranial to it. The photograph at the upper left side of the figure indicates probe positioning... 

Fig. 16.47 a,b. Serous tenosynovitis of the peroneal tendons, a The patient presented with diffuse swelling (arrows) and tenderness in the retromalleolar region following an ankle sprain, b Transverse 12-5 MHz US image at the level of the lateral malleolus (asterisk) shows increased fluid (stars) within the common tendon sheath of the peroneus longus (pi) and peroneus brevis (pb) tendons. The hypoechoic effusion makes the mesotendons (arrowheads) visible. Note the flattened appearance of the peroneus brevis compared with the peroneus longus... 

Fig. 16.48. Mild strain injury of the superior peroneal retinaculum in a patient with a history of ankle sprains. Transverse 12-5 MHz US image over the retromalleolar groove reveals a thickened and hypoechoic retinaculum (arrowheads) connected to the periosteum of the lateral malleolus (LM) by a fibrous lip (asterisk). The peroneus longus (pi) and peroneus brevis (pb) tendons appear normal...

Peroneal tendon tears can be observed in patients following ankle sprains or with a history of chronic instability, especially if they are affected by systemic disorders such as rheumatoid arthritis and diabetes mellitus or are receiving corticosteroids (Kraus and Brodsky 1998 Wang et al. 2005). Clinically, the rupture of peroneal tendons leads to inability to evert and cavovar us foot Tears of the peroneus brevis tendon are most common and present with a typical longitudinal configuration, commonly referred to as split or fis-... 

Fig. 16.51 a-e. Peroneal tendon instability (type III injury), a The patient presented with diffuse swelling and tenderness around the lateral ankle and complete inability to place his foot in eversion, b Internal oblique view of the ankle demonstrates a fibular flake fracture (arrowheads), c Transverse 12-5 MHz US scan obtained with the transducer applied transversely over the lateral malleolus (asterisk) reveals the avulsed bony fragment (arrowheads) and the anterior dislocation of the peroneus brevis (pb) and peroneus longus (pi) tendons, d Transverse 12-5 MHz US scan of the contralateral normal side, e Transverse T2-weighted MR imaging correlation confirms the anterior dislocation of the peroneal tendons... 

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