Peroneal tendinosis as a predisposing factor for the acute lateral ankle sprain in runners

Knee Surg Sports Traumatol Arthrosc. 2016 Apr;24(4):1175-9. doi: 10.1007/s00167-015-3562-3. Epub 2015 Mar 19.


Purpose: A painful episode in the region of the peroneal tendons, within the retromalleolar groove, is a common precipitating event of an acute lateral ankle sprain. A forefoot striking pattern is suspected to cause peroneal tendinosis. The aim of this study is to analyse the role of peroneal tendinosis as a predisposing factor for ankle sprain trauma in runners.

Methods: Fifty-eight runners who had experienced acute ankle sprain trauma, with pre-existing pain episodes for up to 4 weeks in the region of the peroneal tendons, were assessed clinically. Fractures were excluded by conventional radiography. An magnetic resonance imaging (MRI) scan had been performed within 14 days after the traumatic event and was subsequently evaluated by two experienced radiologists.

Results: MRI revealed peroneal tendinosis in 55 patients (95% of the total study population). Peroneus brevis (PB) tendinosis was found in 48 patients (87% of all patients with peroneal tendinosis), and peroneus longus (PL) tendinosis was observed in 42 cases (76%). Thirty-five patients (64%) had combined PB and PL tendinosis. A lesion of the anterior talofibular ligament was found to be the most common ligament injury associated with peroneal tendinosis (29 cases; 53%), followed by a lesion of the calcaneofibular ligament (16 cases; 29%) and a lesion of the posterior tibiofibular ligament (13 cases; 24%).

Conclusion: The results of this study reflect the correlation between peroneal tendinosis and ankle sprain trauma. Injuries of one or more ligaments are associated with further complications. A period of rest or forbearance of sports as well as adequate treatment of the peroneal tendinosis is essential to prevent subsequent ankle injuries, especially in runners. Modification of the running technique would also be beneficial.

Level of evidence: IV.

Keywords: Ankle sprain trauma; Lateral ankle stabilisation; Peroneal tendinosis; Running injury.

MeSH terms

  • Adult
  • Ankle Injuries / physiopathology*
  • Ankle Joint / diagnostic imaging
  • Ankle Joint / physiopathology*
  • Humans
  • Magnetic Resonance Imaging
  • Running / physiology*
  • Sprains and Strains / physiopathology*
  • Tendinopathy / diagnostic imaging
  • Tendinopathy / physiopathology*