Description[edit | edit source]
Origin[edit | edit source]
Insertion[edit | edit source]
Nerve[edit | edit source]
Artery[edit | edit source]
Muscular branches of the peroneal artery.
Function[edit | edit source]
The Peroneus Brevis is responsible for 63% of the power needed to evert the foot as well as assists in plantar flexion along with the Peroneus Longus. The peroneal muscles work together to provide dynamic lateral ankle stability during sudden ankle inversion stress.
Clinical relevance[edit | edit source]
Ankle and foot injuries are commonly seen in physiotherapy with a high prevalence of those injuries occurring at the lateral ankle.
The most common injuries seen with the Peroneus Brevis is to the tendon by way of tendinopathy, dislocation/subluxation, sprain or splitting. Tendon injuries to the Peroneus Brevis are usually caused by inversion or supination forces. With a lateral ankle sprain, it is possible that the Peroneus Brevis can tear and cause swelling at the lateral ankle.
Assessment[edit | edit source]
When assessing a patient for a Peroneus Brevis injury, an overall alignment of the leg and posture of the hindfoot must first be evaluated. Patients that present with hindfoot varus are predisposed to peroneal injury. Assessing the flexibility and correctability of the varus should be performed to determine the use of orthotic management.
Observation: Upon observation, peroneal disorders will often present with swelling just posterior to the fibula or along the lateral wall of the calcaneus. Patients typically present with posterolateral ankle pain that worsens with activity and improves with rest.
Palpation: may present with tenderness along the course of the tendons.
Range of motion testing may show pain with resisted eversion, passive inversion stretch, or resisted plantar flexion of the first ray. Active circumduction of the ankle may re-create tendon subluxation.
Strength testing is likely to elicit pain and will be reduced going into eversion.
Special tests such as the peroneal compression test should be performed to assess pain, crepitus, and “popping” at the posterior edge of the distal fibula during forceful ankle eversion and dorsiflexion.
Treatment[edit | edit source]
Conservative Treatment[edit | edit source]
- Non-steroidal anti-inﬂammatory medication
- Activity modiﬁcation
- Orthoses with lateral forefoot posting in mild cases
- For persistent cases, immobilization in a short-leg cast or controlled ankle movement walker for six weeks may be helpful.
Surgical Treatment[edit | edit source]
Open Synovectomy: The tendon sheath is opened longitudinally and any damaged area of tendon is debrided.
Post-operatively, the foot and ankle are placed in a short-leg cast. Weight-bearing in the cast may begin after two weeks. Range of movement and strengthening are started after casting is discontinued at four to six weeks.
References[edit | edit source]
- Basit H, Eovaldi BJ, Siccardi MA. Anatomy, Bony Pelvis and Lower Limb, Foot Peroneus Brevis Muscle. InStatPearls [Internet] 2019 May 19. StatPearls Publishing.
- Lippert, Lynn S. Clinical Kinesiology and Anatomy. 5th ed. Philadelphia: F A Davis Company; 2016.
- Palastanga N, Soames R. The Lower Limb. In: Anatomy and Human Movement: Structure and function. Edinburgh: Churchill Livingstone; 2012. p. 253–6.
- Davda K, Malhotra K, O’Donnell P, Singh D, Cullen N. Peroneal tendon disorders. EFORT open reviews. 2017 Jun;2(6):281-92.
- Endurance Physio. Ankle Eversion (fibularis longus/brevis) Exercise. Available from:https://www.youtube.com/watch?v=JHyEHEwgc6A&feature=youtu.be [last accessed 13/02/2020]