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Peroneal tendon repair..worth it?

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  • Peroneal tendon repair..worth it?

    I stepped in a hole some 10 years ago and really buggered up my foot. I went to the ER and they took x-rays which I know they will do but I had told them I felt something tore...bone doesn't tear.

    I hobbled along and finally went to see a podiatrist thinking I could get in faster which I could. Oh, you have a difficult foot? Whatever the heck that means. He fiddled around with orthotics and physical therapy. The orthotics made it hurt worse and the PT didn't do much.

    Eventually I went to an orthopedic surgeon who in about 5 minutes told me he would do surgery on it and what was wrong with it...which isn't what is wrong with it. He wanted to fix tendon sublxation...which isn't where or what the problem is. When I said I wanted more info, he said well, call back if you want surgery and threw me a Rx for a wedge orthotic and walked out of the room. Needless to say I didn't go back and have just lived with it.

    Finally when I was into my primary care doc, he wanted me to go see a different ortho doc. The new doc finally said we need an MRI and yep, at least one of the branches of the peroneal tendon is basically shredded and all scarred up. He wants to do a tenolysis and may have to graft depending on how messy things are once he gets the adhesions release.

    I have gotten along all this time. I at first glance look like I walk normally but I don't. That foot rolls to the outside and it has been hard on my hips and pelvis. It also makes walking on uneven ground very difficult. I think at best I am "pasture" sound. Athletic tape is my friend.

    Has anyone had this surgery and did it help? I know that is the goal but what was your actual outcome?

    Thanks, Susan

  • #2
    Hi Susan

    I am in the same boat as you. Been told I need to do surgery. I am terrified that I will end up worse after than before. I'd also love to hear from anyone who has been through this. Apparently a fairly common injury in riders, snowboarders and kite surfers. Anybody out there been through this?


    • Original Poster

      Well, I just read that old thread that someone bumped up.
      is all I can say. But, damn it, I'm tired of the burning, hot poker in the side of the foot pain.

      First though, I have to have another surgery to deal with another very chronic problem. It affects my ability to sit and I figured I had better get that fixed first if I'm going to be one legged. So the foot surgery is going to have to wait until next year.

      Of course, all this when my horse is finally getting the hang of baby collection and is ready for 2nd level. Wahhh. I'm sure she won't mind the time off. I'm hoping I will be able to ride at least in much more comfort than I am now (the sitting problem really affects my riding too).



      • Original Poster

        Just an update.

        I had the surgery in January. Both branches of the peroneal were majorly torn and in an odd spot...much lower than usual. They were torn longitudinally so he was able to make them back into tubes instead of the mashed flat straps they were. He removed a lipoma that had built up from all the scar tissue and adhesions. He did a retinacular release for the heck of it to make sure they stay in their groove and behave even though they were not dislocating. The damage was extensive and he felt it prudent to do that to keep the mechanism working as it should. He also did a tenosynovectomey near the insertion of the posterior tibial tendon to check a tear there. Yes, more surgical damage but I didn't want the one side fixed only to have the other side fail and go through this again...no, no, no. The tear was minor so nothing else needed than cleaning out the tendon sheath.

        This surgery kicked my butt. I was in a cast 3 weeks, then a Cam boot with no weight bearing for 7 weeks total then weight bearing in the boot for 5 more weeks. 2 weeks ago I got out of the boot and thought with a week or so of transition I would be good to go...oh no. The foot feels pretty frozen. I am having problems getting my forefoot to cooperate at the point of breakover so I am walking slowly and with a slight limp. The sensation in that foot is totally wonky. Not numb but not normal but it is slowly improving. I know that all that nerve damage takes time to repair. Next week I finally start physical therapy. MD was not happy with the strength but heck, those tendons have not worked correctly in 10 years so really not much of a surprise on that. Hopefully, the PT will accelerate things because right now, I am improving but more at the speed of a tortoise. The good news is that hot poker in the side of the foot pain is gone. Whohoo.

        I have actually got the OK to return to the barn with a good pair of lace up boots for support. Nobody told me though that I would have major swelling after coming out of the Cam boot. The new boots rubbed the scar raw. So, I went back to the Cam boot at the barn and back to lunging Ms. Marshmallow.
        I have been on pony 3 or 4 times...just walking. We are both really out of shape. I still don't have much energy to do multiple things in a day. I can go ride OR I can go to work. Since I work full time, I haven't done much riding but what I have done, the foot feels pretty stable and not too painful. Finally, after 2 weeks out of the boot, the swelling has stabilized and the incision is almost healed up again so I'll give riding another go. I am getting more energy as walking slowly comes back toward normal. I figure we will do a mostly walking program for the first 3-4 weeks anyway. The horse has been off since October and she got quite chubby over the winter so walking is a fine way to start back.

        So, I'm not really to the point yet, that I can say if it was worth it or not. I think in the end it will be good but it is quite the process...a bit more of a process than I was led to believe it would be. Now I know.



        • #5
          Eek. They wanted to do this on me about 3 years ago. At the time, I had a job that involved lots of driving, and my right foot is the bad one, so I kept putting it off because I didn't want to take major time off work. Have gotten by pretty well by almost always wearing flats and only riding in tall boots for the support. Now that I telecommute, I was kicking the idea around again, but I think you've talked me out of it.


          • Original Poster


            I asked the Doctor about driving because I am single and yep, it is the right foot. I was paniced about not driving for 3 months. He said, to drive with my left foot and go practice. My initial visit was in August and I didn't get the surgery until January so I had lots of time to practice and did fine. In fact, I get in the car and adjust everything for the left foot and I don't need to anymore.

            I think in the end it will be good. The doc was not as forthcoming with the whole story. He made it sound like a 3 month committment and then you are good to go...eh, not exactly. I am eager to start therapy to get everything stretched out and functional again.



            • #7
              I'm going through similar things right now - doc fixed my ATFL and debrided the heck out of my peroneals. I don't think they were actually torn. I saw 2 guys before I picked one. Both told me to expect to be OOC for the better part of 6 months and I wouldn't be really back to normal until 9-12 months afterward. I just got my handicapped parking renewed through October.

              That stinks the doc gave you the soft sell. Mine has been the complete opposite - told me when he recommended it that it would be the worst thing ever and I would be swearing at him for the first week. When I got the boot off he said "It will be about 3 months before this seems like a good idea"

              I'm kind of surprised they let you go back to the barn, I started PT a week & a half ago. The first thing he said was "No Ladders!" (I periodically have to run around ships) I asked last week about ditching crutches when I go into work and he just glared at me. After 2 years of this crap, I think he's gotten a little overprotective.

              It's my right foot too. I found this nifty little thing to drive with my left foot. http://www.plfa.org/ It has worked great.
              Visit my Spoonflower shop


              • Original Poster

                red mares...that is cool. Amazing what you can find on the internet. I am driving fine with the right foot now but ocassionally I realize that I have swapped back to the left one. It got pretty comfortable that way. I found an Evenup to help with ambulating in the boot. It is a little lift thing for my shoe so I wasn't so lop sided in the Cam boot. My hips and back appreciated that.

                I am really careful out at the barn. I rode today...20 minutes at a walk. It actually feels quite good considering. The only problem I am having in that low key endeavor is not having my boot rub the scar raw. Even though the swelling is down from the last time I rode, it still rubbed it raw today. I figure that is all I will be doing until PT gets well underway and I get a little more direction on activity from the physical therapist because yeah, my surgeon isn't the most chatty guy. Technically he is supposed to be one of the best. I have ditched my crutches. I still sometimes bring my scooter to work to get from my car to my department (I work in a fair sized hospital so it is a long way from the parking lot). He wanted me off of everything (scooter and crutches) before I got out of the boot. My handicap parking is good into July and I am hoping I don't need to renew it. I go for my supposedly final followup appointment (5 month post op) in June. Anyway, I am glad to know that I am not as wussy as I thought and this is a work in progress and that I am progressing.



                • #9
                  I had an Even-up... I gave it to my neighbor who broke her ankle last summer after the last surgery b/c I wasn't going to need it again. Ha! Kind of pathetic, but I was in & out of the boot so often last fall, I ended up going shoe shopping with it to find to find the shoe with the perfect heel to match it.

                  I considered going to the barn yesterday. It's 2 hours away, so that's 1 deterrent and 2) PT was going to have kittens if I came in on Monday and said "It's bothering me, but no surprise since I went to the barn". I did that about a half dozen times last year & I think he wanted to beat me for it.

                  I only did 8 weeks in the cast/boot so it a little different. If I'd gone with the other surgeon I would have been in it for 12, so I don't feel like a wimp for still using them. Except I'm tired of them & they are tearing up my shoulder.
                  Visit my Spoonflower shop


                  • #10
                    Last week I had a peroneal tendon repair surgery done. The tendon was subluxing (especially while riding) and as a result one of the tendons had a longitudinal tear. This was because there was no groove in the fibula keeping the tendons in place. Also the calf muscle belly fibers ran down abnormally low which caused additional irritation. So the tendon tear was repaired as well as the retinaculum. They also carved a groove in the fibula to keep the tendons from subluxing again and cut some of the calf muscle belly fibers that were too long. Obviously every experience is different but has anyone had any luck with the surgery? How soon until you were back in the saddle or did you try no stirrups for awhile?


                    • #11
                      Originally posted by Kellyxc92 View Post
                      Last week I had a peroneal tendon repair surgery done. The tendon was subluxing (especially while riding) and as a result one of the tendons had a longitudinal tear. This was because there was no groove in the fibula keeping the tendons in place. Also the calf muscle belly fibers ran down abnormally low which caused additional irritation. So the tendon tear was repaired as well as the retinaculum. They also carved a groove in the fibula to keep the tendons from subluxing again and cut some of the calf muscle belly fibers that were too long. Obviously every experience is different but has anyone had any luck with the surgery? How soon until you were back in the saddle or did you try no stirrups for awhile?
                      I had surgery on my peroneals and ATFL the end of February. My OS was ok with me riding went I went to see him last month. He also admits to having no idea about what's involved with riding; as a point of reference, I'm not allowed to think about running until August (6 mos). My PT basically said "He!! No" when I brought up riding after I last saw the OS. This PT has dealt with me riding before . I may try and putz around on a school horse next weekend without stirrups if I get up early enough.
                      Visit my Spoonflower shop


                      • Original Poster

                        I was back on the horse after I got out of the boot (3 months) but I'm not sure you would call it riding. Basically she was giving me pony rides. Now, 6 months out (surgery was 1/21) I am pretty comfortable riding and feel my foot is pretty reliable. I can get some soreness where the retinalcular release was done toward the end of a session but have been quite pleased. I am back to schooling my horse more seriously although in dressage and flat work only. I don't jump. I went straight back to riding with stirrups. I have an issue with my tailbone and sitting full out on that is not comfortable and I had no issue with the stirrups. In fact, I took it as an opportunity to help stretch things out.

                        All in all, it feels pretty good. The only pain I'm having is in the area of the posterior tibial tendon work. It feels really tight down into my arch. It was initially just very tight feeling but is now getting painful. I am thinking an adhesion and am trying some massage and tissue release on it. If that doesn't help I will go back before my final visit which is currently scheduled for Sept. It is quite nice not to have that burning, hot poker in the side of the foot pain anymore so I call it successful. My foot is feeling stronger than preop and my gait is slowly feeling more normal...at least at times. Recovery is long...longer than the orthopod fessed up to it being but everything I read on rehab (after the surgery) says up to a year. I'm half way there.



                        • #13
                          I am facing surgery for peroneal tendon repair in the fall and you guys are scarring the heck out of me! I just spent the last 6 months recovering from the injury that caused the tear in the first place and the thought of going back to non weight bearing for several weeks or months is killing me. The doctor told me to put it off until a time that is convienient for me. That would be never! Anyway, I'm going to do my best to keep riding over the summer and have the surgery in the fall. It was a choice between that and having the surgery now and not being able to ride until June. Do any of you regret having the surgery? I know the recovery time is long but was the end result favorable?


                          • Original Poster

                            Hi samz...good luck on your surgery.

                            Was it worth it? I think so...not a very resounding response.
                            I am a little over a year out. The foot is still really good pain wise but doesn't really feel any stronger/stable than before the surgery which is somewhat disappointing. Every time I saw the surgeon, he just said it was weak. Well, yes but it isn't seeming to get any stronger. I start out great guns in the morning but by evening or mid exercise my foot starts rolling out just like it has for the last 10 years. Athletic tape or K tape helps that quite a bit. Not having that constant foot pain is really nice though. I did do some PT for rehab but I think I need someone to work with me on correct biomechanics. After seeing my PCP (see below), I may have another visit with the foot surgeon...maybe some orthotics or inserts might help the rolling out.

                            The other problem from my foot (I think) is that from walking wonky for so long, my hip or the soft tissues around my hip or my back??? are killing me. This issue has gotten worse since the surgery. I didn't have any problems with the hip at all while I was whizzing about on the scooter but since I have been walking on the "new" foot...ouch. I have tried several things (PT, yoga, steroids) and nothing has helped so I am heading to my PCP next week to see if I need some imaging to figure out exactly where the problem is. This issue is a problem because it has caused me to temporarily give up riding. When I emailed my PCP he replied that I must be hurting if I quit riding my horse. Of course I didn't tell him that the stinking winter weather isn't helping but it has truly become painful to ride.

                            I let my injury go for so long (not for lack of trying to get it diagnosed), that it may never get even close to normal. But as I said...a pain free foot has been very nice.



                            • #15
                              Kyrabee, how much PT did you do after your surgery? I had one of my rotator cuff tendons repaired and I've been in intense PT for about 8 months. I know it's not the same tendon but perhaps you need some more therapy to help get your strength back? I'm glad your pain is gone, hopefully you will be able to get the strength back too!
                              Freedom is the ability not to care what the other person thinks...

                              Got air?! Member of the Asthmatic Riders Clique


                              • Original Poster

                                They released me after about 2 months of sort of on/off PT (PT's vacation and mine). I have home exercises of course which I did pretty religiously for about 6 months. The foot exercises have tailed off as the hip issue has taken over. I need 36 hours in a day to accomodate the therapy for all my infirmities.

                                I am thinking I need to re-visit the surgeon. I really think I have some adhesions in the area of the posterior tibial tendon work which is contibuting to the roll out of my foot as my arch has little to no give in it. I will ask my PCP tomorrow what he thinks.



                                • #17
                                  Originally posted by Kyrabee View Post
                                  I need 36 hours in a day to accomodate the therapy for all my infirmities.
                                  I hear you on that! My physio clinic has adopted me, they joke I'm there so much I should just work there. I think I might take them up on it if we weren't moving!
                                  Freedom is the ability not to care what the other person thinks...

                                  Got air?! Member of the Asthmatic Riders Clique


                                  • #18
                                    Hi, I thought I would chime in on this thread with my experience. I also posted this on the Trashed Knee and Ankle Brigade thread, but want to make sure people with peroneal tendon problems specifically can see it.

                                    I have a bad right ankle. Recently had peroneal tendon surgery--large split tear of the peroneal brevis which couldn't be repaired and saved, so a tenodesis was made to the peroneal longus. March 26. I had read a lot of nightmare blogs and posts about the surgery and recovery, and I was very nervous about the recovery, but so far it hasn't been that bad. I'm still non-weight bearing on that leg for another week, but after that I can start walking with my CAM walker/boot and use of a crutch or cane. I can start gentle riding at 8 weeks post op, unless he sees something to contraindicate that when I go back for a follow up appointment in 3 weeks.

                                    Ankle feels pretty good, just a little mild swelling. I haven't needed much pain medication at all, even during the first few days post op. Very little swelling even in the beginning as long as I kept it elevated as much as possible. I still elevate it most of the time I'm sitting. I think a lot of credit goes to my surgeon--I think he is very good and "got in and got out" without traumatizing things any more than needed.

                                    I am using a knee walker/scooter and I HIGHLY recommend anyone with foot/ankle surgery to get one rather than using crutches. My insurance pays for the rental. I have a pair of crutches as well, but I haven't touched them since bringing them home. I live alone and am able to take care of almost all my own household chores, cooking, laundry, personal care, and small pet care because of my wonderful knee walker. I hired someone to take care of my two horses kept at home--a responsible teenager I hired previously when I had a hip replacement is working out wonderfully.

                                    I "knee walked" out through my yard to see the horses this past weekend, which was a real pick me up. The regular "inside" knee walker is tough to use on the rough ground outside, so I bit the bullet and purchased an all-terrain knee walker called a "Knee Rover." Just received that and haven't been able to test it outside yet because the weather isn't cooperating. It's got some decent tread on the wheels, but still no match for ice and snow that we got yesterday/last night. It drives me crazy to have to stay inside so much, so the all-terrain knee walker is a good investment in my sanity. Even after I can start walking on the leg, I doubt I'll be able to walk very far at first, so I'll knee walker longer distances (like out through my yard to the barn) and then "regular" walk around once I get there. They also make seated walker/scooters similar to a knee walker, only with a bike seat, for injuries higher than the ankle.

                                    I think everyone's experience with peroneal tendon surgery and recovery is different. I tend to heal quickly and I've also been through several other major ortho surgeries, so I guess in the grand scheme of things for me, this hasn't been anywhere near as bad as something like my hip replacements (although they turned out well too--just more pain and a generally more difficult recovery in the earlier stages). So far, I'm glad I had the peroneal tendon surgery done and am looking forward to being able to walk like a normal person without feeling like a knife is stabbing into the outside of my ankle.

                                    I also have a small longitudinal tear and a large area of thickening/degeneration on the Achilles that will need surgical repair after the peroneal is totally healed. My surgeon thinks that will have a similar recovery period, but I wouldn't be surprised if it's a little longer because he is talking about probably needing to cut the bad chunk out of the Achilles and do a tendon transfer. But, he won't know until he gets in there and actually sees it.

                                    Interesting how so many equestrians have ankle problems.
                                    Horse'in around in Upstate NY


                                    • Original Poster

                                      Well...I'm back to PT starting next week. I went back to the surgeon concerned with my walking mechanics and his reply which is almost exactly what I thought he would say...the foot is weak.
                                      Totally dismissed the arch issue...you have high rigid arches...yes, I know that but the right foot is way more rigid. He didn't think so. You ought to try walking on it dude.

                                      So, I am going trying PT for another round to see if I can strengthen the peroneal muscle up. I don't know. The tendons were torn for 10 years and I'm not sure strenthening up that little skinny muscle is going to keep my foot from rolling out. He wasn't very helpful regarding orthotics or a specific kind of shoe either. He said I could make my own.
                                      His obnoxius fellow (post graduate orthopedic doc doing a rotation in specialty work) suggested an arch support (WTH) or MAJOR RECONSTRUCTIVE SURGERY (he very much emphasized that twice. Like I would let them do it again when the first time didn't completely fix the issue. What a prick (sorry but young, inexperienced with an attitude).

                                      So, I will try more physical therapy and hope for the best. I going to a different one than did my immediate post op PT and maybe he will have some bright ideas. I don't have the poker in the side of the foot pain anymore which is quite nice. If I could get a handle on my walking mechanics, I will be happy (happier anyway).

                                      As long as I don't walk tons, my hip/thigh are doing better. Luckily, riding isn't walking on my part at least and that is going well.



                                      • #20
                                        I used a wedge inside the lateral part of my shoe that kept me from supinating so much. That really helped me manage the day to day pain while I was waiting for surgery. I bought the rubber ones on this site, but the whole lateral one intrigued me as well. I'm hoping I won't need anything after I heal up. Hope you can get some relief.

                                        Horse'in around in Upstate NY