Neuropathic patients have an increase in dynamic plantar foot pressures placing them at risk for plantar ulceration. Instruments such as the EMED-SF system can be helpful in detecting possible sites of plantar ulcerations by locating the areas of maximum pressure.

A low lying peroneus brevis muscle belly is a rare anomaly. There are few published studies that support presence of this anomaly as an etiology for peroneal tendon tear. However, the association between a low lying peroneus muscle belly (LLMB) and tendon subluxation is not well explored. In this retrospective study, the magnetic resonance imaging (MRI) and intraoperative findings of 50 consecutive patients undergoing a primary peroneal tendon surgery, in a five year period, were assessed. The sensitivity and specificity of MRI, in comparison to intraoperative findings for identifying peroneal tendon disease was investigated. Presence of associated peroneal tendon pathologies in patients with and without LLMB was compared. Sensitivity of MRI was high in identifying peroneal tenosynovitis (81.58%) and tear (85.71%). Although the sensitivity of MRI for detecting a LLMB (3.23%) and tendon subluxation (10.00%) was low, MRI had high specificity at 94.74% and 100%, respectively. Intraoperatively, LLMB was seen in 62.00% of patients with chronic lateral ankle pain and was associated with 64.52% cases of tenosynovitis, 29.03% cases of tendon subluxation, and 80.65% cases of peroneus brevis tendon tear. While presence of a LLMB did not show any statistically significant association with peroneus brevis tendon subluxation, among the 10 patients with intraoperatively observed tendon subluxation, 9 had a concomitant LLMB. More studies with a larger patient population are needed to better study the role of a low lying muscle belly as a mass occupying lesion resulting in peroneal tendon subluxation.

A wide range of factors contribute to the complexity of the management plan for an individual patient, and it is the surgeon's responsibility to consider the clinical variables and to guide the patient through the perioperative period. In an effort to address a number of important variables, the American College of Foot and Ankle Surgeons convened a panel of experts to derive a clinical consensus statement to address selected issues associated with the perioperative management of foot and ankle surgical patients.

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