Musculoskeletal Management of a Patient With a History of Chronic Ankle Sprains: Identifying Rupture of Peroneal Brevis and Peroneal Longus With Diagnostic Ultrasonography

Abstract

Objective: The purpose of this case report is to describe the use of mobilization and eccentric exercise training for a patient with ankle pain and a history of chronic ankle sprains and discuss the course of diagnostic decision making when the patient did not respond to care. Clinical Features: A 48-year-old police officer who had sustained multiple ankle sprains throughout his life presented with pain and restriction in his ability to walk, run, and work. The Global Rating of Change Scale score was − 6, the Numeric Pain Rating Scale score was 7/10, and the Lower Extremity Functional Scale score was − 33. Palpation of the peroneus longus and brevis muscles and inversion with overpressure reproduced the chief concern (Numeric Pain Rating Scale 7/10). The patient was initially diagnosed with chronic peroneal tendinopathy. Intervention and Outcome: Treatment included lateral translation mobilization of the talocrural joint combined with eccentric exercise using an elastic band for the peroneal muscles. The patient reported improvement in pain and function during the course of intervention but not as rapidly as expected. Therefore, follow-up ultrasonographic imaging and radiography were performed. These studies revealed partial rupture of the peroneal brevis muscle and total rupture of the peroneal longus muscle. Conclusion: A patient with long-term concerns of the foot complex with a diagnosis of peroneal tendinopathy showed slight improvement with eccentric exercises combined with manual therapy of the talocrural joint. After a course of treatment but minimal response, a diagnosis of tendon rupture was confirmed with diagnostic ultrasonography. Clinicians should be aware that when injuries do not improve with care, tendon rupture should be considered.

Ultrasonography Comparison of Peroneus Muscle Cross-sectional Area in Subjects With or Without Lateral Ankle Sprains

“…15 Atrophy, tendon rupture, and delayed reaction times of the peroneus muscles have been related to ankle sprains. 2,16 RUSI measurements have also revealed a 14.7% reduction in the CSA of the peroneus muscles and a 10% reduction in peroneus muscle thickness in participants with pes planus. 15 Nevertheless, to date, no study has compared the peroneus longus and the peroneus brevis separately or assessed their soft tissue CSA changes in relation to ankle sprains.…”

“…28,29 Participants with conditions involving the peroneus quartus muscle, tendon rupture, or peroneus longus and the peroneus brevis muscles of a large volume that did not permit proper RUSI evaluation within the limits of the ultrasound transducer were also excluded. 16,30 In addition, participants who exercised for less than 1 hour or more than 3 hours per week or at a high intensity (eg, competition) were excluded because of CSA changes in the lower limbs (eg, peroneal muscles) that may be generated by exercise, injury, or disuse. 31 The study protocol was approved by the Intervention Clinical Committee of the European University of Madrid, Spain (CIPI/044/15).…”

Ultrasound Imaging of Crural Fascia and Epimysial Fascia Thicknesses in Basketball Players with Previous Ankle Sprains Versus Healthy Subjects

“…Numerous studies by Ultrasound imaging have related atrophy of muscles of leg, tendon ruptures, tendinopathies, delayed reaction times of the peroneus muscles, their cross-sectional area, to ankle sprains [ 30 , 31 , 32 ]. Nevertheless, to date, no study has compared the fascial thicknesses measured by ultrasound imaging in relation to recurrent ankle sprains and chronic ankle instability.…”

Managing rare fractures – a case report of an isolated avulsion fracture of the peroneus longus tendon

“…Literature regarding the role of physiotherapy in relation to these injuries is limited, and at the moment, there are no specific guidelines in practice. Some researchers have claimed to treat chronic ankle pain in patients following multiple subtle injuries to their joint by means of physiotherapy to provide an improved functional ability [ 6 ].…”