Peroneus Tertius Syndrome - Symptoms, Causes, and Treatment

Introduction:

Peroneus Tertius Syndrome or peroneal tendonitis is a rare condition affecting the lower leg's peroneus tertius muscle. It is a small muscle that passes down the outer aspect of the lower leg, from knee to ankle. It is responsible for dorsiflexion (raising the foot upwards towards the shin) and eversion (foot rotation with the sole facing away from the midline of the body) of the foot. This syndrome typically occurs in athletes who participate in activities that require repetitive ankle dorsiflexion, such as running, jumping, and kicking. It can also occur in individuals with a pre-existing foot or ankle condition or those who have undergone ankle surgery.

What Are the Causes of Peroneus Tertius Syndrome?

• Overuse or Repetitive Strain - The most common cause of Peroneus tertius syndrome is overuse or repetitive strain. Athletic activities such as running, jumping, and kicking are most likely result in the development of this syndrome due to the repetitive stress placed on the peroneus tertius muscle. This type of strain can lead to micro-tears in the tendon, causing inflammation and pain.

• Foot or Ankle Abnormalities - Individuals with foot or ankle abnormalities may also risk developing Peroneus tertius syndrome. Flat feet, high arches, or ankle instability can alter the biomechanics of the foot and ankle, leading to increased stress on the peroneus tertius muscle. This can cause micro-trauma to the muscle, resulting in inflammation and pain.

• Ankle Surgery - Ankle surgery, especially procedures that involve the peroneus tertius muscle or tendon, can also lead to the development of Peroneus tertius syndrome. This is because surgery can cause trauma to the muscle and surrounding tissues, leading to inflammation and pain.

• Ankle Sprains - Ankle sprains can cause damage to the ligaments that support the ankle joint. This can lead to instability of the ankle joint, which can alter the biomechanics of the foot and ankle, increasing stress on the peroneus tertius muscle. Over time, this can lead to micro-trauma and the development of Peroneus Tertius Syndrome.

What Are the Symptoms of Peroneus Tertius Syndrome?

The following are some of the common symptoms of this syndrome:

• Pain: Pain is a common symptom of Peroneus tertius syndrome. It is typically felt outside the lower leg, near the ankle joint. The pain is dull or sharp but worsen during activities involving ankle dorsiflexion, such as running, jumping, or kicking.

• Swelling: Swelling is another common symptom of Peroneus tertius syndrome. It may occur outside the lower leg, near the ankle joint. The swelling may be mild to moderate. It also shows redness or warmth in the affected area.

• Clicking or Popping Sensation: In some cases, Peroneus tertius syndrome may cause a clicking or popping sensation during ankle movement. This may be due to friction between the tendon and the surrounding tissues.

• Difficulty Walking: The pain and swelling associated with Peroneus tertius syndrome may make it difficult to walk or bear weight on the affected leg. This can significantly affect an individual's mobility and quality of life.

• Numbness or Tingling: In rare cases, Peroneus tertius syndrome may cause numbness or tingling in the affected leg or foot. This may be due to the compression of nerves that run along the outside of the lower leg.

What Is the Diagnosis of Peroneus Tertius Syndrome?

• The diagnosis of Peroneus tertius syndrome typically involves a comprehensive physical examination and a review of the patient's medical history. During the physical examination, the doctor may perform various tests to assess ankle and foot's strength, flexibility, and range of motion.

• The doctor may also palpate the peroneus tertius muscle to assess for pain or tenderness.

• Imaging tests, including X-rays or MRI (magnetic resonance imaging) scans, are done to confirm the diagnosis. Imaging studies also help rule out other conditions that may cause similar symptoms, such as ankle sprains or tendonitis.

• Sometimes, the doctor may inject a diagnostic injection of a local anesthetic into the peroneus tertius tendon. If the injection relieves the patient's pain, it may confirm the diagnosis of Peroneus tertius syndrome.

What Is the Treatment of Peroneus Tertius Syndrome?

The treatment requires both non-surgical and surgical approaches, depending on the severity of the condition.

Non-Surgical Treatment Options:

• Rest: Resting the affected leg and avoiding activities aggravating the symptoms can help reduce pain and inflammation.

• Ice and Heat Therapy: Applying ice packs or heat pads to the affected area can help reduce pain and swelling.

• Physical Therapy: Physical therapy exercises improve strength, and flexibility. It increases the range of motion, and reduces the risk of further injury.

• Medications: Taking nonsteroidal anti-inflammatory drugs (NSAIDs) or Acetaminophen, which are available without a prescription, may help reduce pain and inflammation.

Surgical Treatment Options:

• Tenodesis: This surgical procedure involves reattaching the peroneus tertius tendon to a nearby bone, such as the cuboid or fifth metatarsal bone. This can help stabilize the ankle and reduce pain and swelling.

• Tendon Transfer: In some cases, a nearby tendon, such as the peroneus longus tendon, may be used to replace the peroneus tertius tendon. This can help restore ankle stability and function.

• Arthroscopy: This minimally invasive surgical procedure involves inserting a small camera into the ankle joint to visualize and repair any damage to the surrounding tissues.

What Is the Prevention of Peroneus Tertius Syndrome?

There is no proven way to prevent peroneus tertius syndrome. However, several steps can reduce the risk of developing this condition.

• Warm-Up and Stretch: Before engaging in any physical activity, it is important to warm up the muscles and stretch the lower leg and ankle to help prevent strains and injuries.

• Wear Proper Footwear: Shoes should be of proper fitting and provide adequate support to help reduce the risk of ankle and foot injuries.

• Avoid Overuse: Avoiding repetitive activities that stress the lower leg and ankle, such as running on hard surfaces or performing high-impact activities, can help reduce the risk of developing Peroneus Tertius Syndrome.

• Gradually Increase Activity: Increasing the intensity and duration of physical activity gradually can help prevent overuse injuries and reduce the risk of developing Peroneus tertius syndrome.

• Seek Medical Attention: It's crucial to consult with a healthcare provider if you have enduring pain or swelling in the lower leg or ankle. Early diagnosis and immediate treatment may prevent complications and improve the outcome of this condition.

Conclusion:

Peroneus tertius syndrome is a relatively rare condition that can cause pain, swelling, and difficulty with lower leg and ankle mobility. Although the exact cause is uncertain, the peroneus tertius tendon's overuse or injury is related to this condition. Treatment done by a combination of non-surgical and surgical interventions and early diagnosis and intervention can help prevent complications and improve outcomes. Individuals can reduce their risk of developing Peroneus Tertius Syndrome and other related conditions by preventing ankle and foot injuries.