Assessing the Feasibility of Non-Surgical Options for a Peroneus Longus Rupture
Greetings everyone, Allow me to introduce myself: I am a 62-year-old male, standing at 188 cm tall and weighing 81 kg. I do not smoke and was diagnosed with multiple sclerosis back in 1995. Despite the diagnosis, I remain fully mobile with only minor disabilities. My current medications include Modafinil and pregabalin, and I do not have any significant health issues beyond that. This is the (fingers crossed) concluding complication stemming from an injury to my lateral malleolus and fractures of the proximal fifth metatarsal I sustained in August 2022. After enduring two and a half years of sporadic bouts of intense and incapacitating pain in my lateral hindfoot and ankle, I ultimately experienced a complete tendon rupture. The ultrasound report indicates a full-thickness tear of the peroneus longus tendon near the fibula, with the tendon ends separated by as much as 16 mm. It also notes a thickening consistent with tendinosis in this area. Additionally, the report states that the peroneus brevis tendon exhibits some heterogeneous changes distal to the fibula, which may suggest tendinosis, but there is no clear tear. Mild tenosynovitis of the peroneal tendon was observed, accompanied by some adjacent subcutaneous fat swelling. Importantly, the anterior syndesmotic ligament, along with the ATFL and CFL ligaments, remain intact. Following these findings, the radiologist suggested that I consult with an orthopedic surgeon, as expected. To add a little levity: the moment a tendon ruptures can be accompanied by an incredibly loud sound and extreme pain. I went down hard, and the noise was sufficient for one of my contractors to hear it. **Now, here's my pressing question:** Considering that there is a 16 mm gap between the tendon stumps and the general deterioration of both the longus and brevis tendons, what are my chances of avoiding surgical intervention? I have successfully sidestepped surgery on my legs up until this point, and I'd like to believe I can maintain this streak. However, I am starting to feel like I may not be able to escape my orthopedic surgeon's recommendations this time. Regrettably, I haven't been able to find any reliable online resources that offer guidance on the implications of the separation distance between tendon ends or how the accompanying pathological changes might affect the decision to pursue surgical options. Please feel free to share your honest thoughts. I appreciate any insights or opinions you can offer. Thank you!
Answers (1)
3/30/2025, 12:40:38 AM
OpenHealth AI
It sounds like you’re dealing with a complex injury, and I appreciate how challenging this must be for you. A complete rupture of the peroneus longus tendon, especially with a significant gap, typically poses serious challenges to spontaneous healing. Here’s a breakdown of your situation and some guidance on how to approach it:
Main Points
- Tendon Gap and Healing: A 16 mm gap between the tendon ends generally reduces the likelihood of healing without surgical intervention.
- Tendinosis and Tenosynovitis: The deterioration of both the longus and brevis tendons suggests a chronic issue, which may complicate non-surgical options.
- Consultation Importance: Engaging with your orthopedic surgeon is essential for a tailored approach to your care.
Explanation
The peroneus longus tendon plays a crucial role in stabilizing the lateral aspect of the ankle. When it ruptures, especially with a wide separation, the chances of the tendon healing naturally diminish. Tendons typically heal best when their ends are closely approximated. Given your history of issues stemming from previous injuries, and the noted changes in the tendons themselves, the condition becomes even more complex.
Next Steps
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Consult with Orthopedic Surgeon: This is crucial, as your surgeon can provide a detailed evaluation of your specific situation, including the chance of successful non-surgical management versus the recommendations for surgery. Ensure to express your desire to explore all options.
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Consider Non-Surgical Management: If the decision is made against surgery, explore options such as:
- Physical Therapy: Focused rehabilitation may help strengthen the surrounding muscles and improve stability, which is vital given your history with mobility issues.
- Bracing: An ankle brace can provide support to the joint, improve function, and may help alleviate pain while allowing for some mobility.
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Monitor Symptoms: Keep a detailed diary of your symptoms, activities, pain levels, and any limitations you experience. This information will be useful for both your orthopedic surgeon and physical therapist.
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Lifestyle Modifications: Engage in gentle, non-weight-bearing exercises to maintain mobility without stressing the ankle. Activities like cycling might be suitable, depending on pain levels.
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Stay Informed: While you seek more information, reliable resources can include academic journals or reputable medical websites that discuss tendon injuries, which may provide additional context on your condition.
Remember, it’s essential to prioritize your overall health and mobility. Communicating openly with your healthcare providers about your goals and concerns will help ensure you receive the best care for your situation. Good luck, and take care!
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