Tenosynovitis of the peroneal tendons associated with a hypertrophic peroneal tubercle: radiography and MRI findings

Abstract

SUMMARYAn enlarged peroneal tubercle can cause a peroneal tendon tear and/or tenosynovitis due to chronic friction. We present the case of a 45-year-old man with tenosynovitis in the peroneus longus and brevis tendons associated with a hypertrophic peroneal tubercle. On admission to our facility, the patient presented with pain while walking and had a fixed mass on the lateral aspect of his right foot. In addition, an osseous prominence corresponding to a hypertrophic peroneal tubercle was seen on the lateral side of the right calcaneus on radiography. MRI confirmed the hypertrophic peroneal tubercle and revealed high-signal intensity within the peroneus longus and brevis tendons along with fluid in their sheaths. BACKGROUND

Aging and tenosynovitis of the peroneal tendons: the cause and management

“…9 Excessive sport activities are the most likely cause for development of peroneal tenosynovitis in people having hypertrophied peroneal tubercle; tenosynovitis is attributed to the chronic irritation of the tendons and tendon sheath with the enlarged tubercle. 10 Peroneal tubercle on the calcanei was identified in 90.4% of human skeletons; the length, height and width of the tubercle were 13.04, 9.44 and 3.13 respectively; the tubercle was prominent in 30% of cases. 11 In another study, peroneal tubercle was considered hypertrophied when it is 5 mm in width.…”

Diagnosis and Operative Treatment of Peroneal Tendon Tears

“…The longus is especially vulnerable to damage from enlargement or irregularity of the tubercle, though either tendon may be affected ( Figure 3C). [5][6][7]30,52 As the peroneus longus tendon courses distally to the plantar base of the first metatarsal, it makes an acute turn under the cuboid, increasing the mechanical stress on the tendon. Frequently, the peroneus longus tendon has an embedded os peroneum ( Figure 3A), which is located at the cuboid tunnel and sometimes slightly proximal to it; it serves as a mechanical fulcrum, similar to other sesamoid bones in the body.…”

“…Observational studies have shown tendon tears to occur at the tip of the fibula or at bony prominences where there is pressure against them (Figure 1A), 3,7,22,30,51 suggesting that the tears are mechanical in origin. Attenuation of the blood supply may also contribute to peroneal tendon tears.…”

“…22 Although 20% to 60% of patients in the literature have been reported to have a sentinel event that precipitated their lateral ankle pain, the event is often remote, and the tears occur over an extended interval prior to the time of presentation. 3,22,39 Observational studies have shown tendon tears to occur at the tip of the fibula or at bony prominences where there is pressure against them ( Figure 1A), 3,7,22,30,51 suggesting that the tears are mechanical in origin. Attenuation of the blood supply may also contribute to peroneal tendon tears.…”