Abstract
Objective
Ankle sprain is the most frequently occurring acute injury in tennis, accounting for 20–25% of all injuries. In the current paper, we assess the cause of ankle sprain and suggest possibilities to be considered during diagnosis.
Methods
We assessed a professional tennis player with a partial tear of the long peroneal tendon after an ankle sprain by physical exam, X‐ray and MRI.
Results
Conservative treatment by means of soft cast and propriocepsis training led to full recovery.
Conclusion
Peroneal tendon disorders must be part of the differential diagnosis after ankle sprain in the professional athlete.
An ankle sprain is the most frequent occurring acute injury in tennis, accounting for 20–25% of all injuries. A flexion supination trauma is commonly the cause of this sprain, in which the lateral ligaments are most often affected.4
However, an ankle sprain may lead to other injuries in the leg and a peroneal tendon lesion must be part of the differential diagnosis.
Methods
A former Davis Cup player and multiple doubles Grand Slam winner presented at the outpatient clinic after a tennis match in regular league tennis. The previous day, during the last point of his doubles match, he twisted his right ankle and felt something tear. He described a feeling as if some fluid spread immediately through his right leg. The ankle had swollen during the course of the day. Gait was undisturbed.
Physical examination demonstrated an undisturbed walking pattern. Heel–toe gait was possible. Minor swelling existed just distal to the fibula of the right ankle. The right ankle showed full range of motion without signs of instability. The neurovascular status was intact.
Conventional X‐ray of the right ankle showed no fracture. Small osteophytes were seen around the ankle joint. There was soft tissue swelling on the ventral and lateral side of the ankle joint.
What is already known about this topic
A partial lesion of the long peroneal tendon may be treated conservatively.
What this study adds
Peroneal tendon lesions must be part of a differential diagnosis after ankle sprain in professional athletes.
Further examination by means of MRI showed swelling of the proximal right long peroneal tendon. The distal long peroneal tendon showed a thin aspect in comparison to the contralateral ankle with an evident fluid sign. This is suggestive for a partial tendon tear. Furthermore, some joint effusion was present without evident intra‐articular damage (Fig 1).
Figure 1 MRI T2‐weighted coronal image of both ankles (right ankle on the left side). The usual hypo‐intense long peroneal tendon (right ankle) is surrounded by an evident fluid signal, which continues into the tendon. This is suggestive for a partial tear. The normal short peroneal tendon is riding just above it.
Diagnosis of a partial rupture of the long peroneal tendon was made. Functional treatment was undertaken by 3 weeks of soft cast. The patient was allowed to perform an adapted training schedule. An extensive propriocepsis program was initiated at time of diagnosis. This conservative treatment resulted in full recovery. The patient won the national men's league tennis championships just 6 weeks after the initial trauma.
Discussion
A partial tear of the long peroneal tendon is an uncommon, sometimes overlooked diagnosis after a common ankle sprain. Primary conservative treatment for acute peroneal tendon disorders is the treatment of choice.3,6 Surgical repair is advocated in concomitant tears of both the long and short peroneal tendon.5
Misdiagnosis of a peroneal tendon lesion may lead to ankle instability, persistent pain, and chronic subluxation of these tendons.1 Conservative treatment may be attempted in cases of chronic peroneal disorders, but results have not been satisfactory.6
In 1979, Zoellner and Clancy presented a surgical technique for this problem by deepening the tendon groove.7 In subsequent years, different techniques (eg, tendon transfer, bone‐block procedures) have been advised; however, none has been shown to be superior to Zoellner's technique.2,3
Conclusion
Peroneal tendon lesions must be part of a differential diagnosis after ankle sprain in professional athletes. Conservative functional treatment led to full recovery in our case of a professional tennis player.
Footnotes
Competing interests: None declared.
References
- 1.Dombek M F, Lamm B M, Saltrick K, Mendicino R W, Catanzariti A R. Peroneal tendon tears: a retrospective review. J Foot Ankle Surg 200342250–258. [DOI] [PubMed] [Google Scholar]
- 2.Ferran N A, Oliva F, Maffulli N. Recurrent subluxation of the peroneal tendons. Sports Med 200636839–846. [DOI] [PubMed] [Google Scholar]
- 3.Fitzgerald R H, Kaufer H, Malkan A L.Orthopaedics. London: Mosby, 20021638–1644.
- 4.Pluim B, Safran M.From breakpoint to advantage. Vista, California: Racquet Tech Publishing, 2004143
- 5.Redfern D, Myerson M. The management of concomitant tears of the peroneus longus and brevis tendons. Foot Ankle Int 200425695–707. [DOI] [PubMed] [Google Scholar]
- 6.Scanlan R L, Gehl R S. Peroneal tendon injuries. Clin Podiatr Med Surg 200219419–431. [DOI] [PubMed] [Google Scholar]
- 7.Zoellner G, Clancy W J. Recurrent dislocation of the peroneal tendon. J Bone Joint Surg Am 197961292–294. [PubMed] [Google Scholar]