Nishikawa Danilo Ryuko Cândido, Duarte Fernando Aires, Saito Guilherme Honda, de Cesar Netto Cesar, Fonseca Fábio Correia Paiva, de Miranda Bruno Rodrigues, Monteiro Augusto César, Prado Marcelo Pires
Department of Orthopedics, Foot and Ankle Surgery, Hospital of the Municipal Public Servant of São Paulo (HSPM), Aclimação 01532-000, São Paulo, Brazil.
Ortocity Orthopaedic Clinic, Lapa 05078-000, São Paulo, Brazil.
World J Orthop. 2020 Feb 18;11(2):137-144. doi: 10.5312/wjo.v11.i2.137.
Peroneal tendon disorders are common causes of lateral hindfoot pain. However, total rupture of the peroneal longus tendon is rare. Surgical treatment for this condition is usually a side-to-side tenodesis of the peroneal longus tendon to the peroneal brevis tendon. While the traditional procedure involves a long lateral curved incision, this approach is associated with damage to the lateral soft tissues (up to 24% incidence).
A 50-year-old female had developed pain at the lateral aspect of the hindfoot 1 mo after an ankle sprain while walking in the street. Previous treatments were anti-inflammatory drugs, ice, rest and Cam-walker boot. At physical exam, there was pain and swelling over the course of the peroneal tendons. Ankle instability and cavovarus foot deformity were ruled out. Eversion strength was weak (4/5). Imaging showed complete rupture of the peroneal longus tendon associated with a sharp hypertrophic peroneal tubercle. Surgical repair was indicated after failure of conservative treatment (physiotherapy, rest, analgesics, and ankle stabilizer). A less invasive approach was performed for peroneal longus tendon debridement and side-to-side tenodesis to the adjacent peroneal brevis tendon, with successful clinical and functional outcomes.
Peroneus longus tendon tenodesis can be performed through a less invasive approach with preservation of the lateral soft tissue integrity.
腓骨肌腱疾病是后足外侧疼痛的常见原因。然而，腓骨长肌腱完全断裂较为罕见。针对这种情况的手术治疗通常是将腓骨长肌腱与腓骨短肌腱进行端端吻合。传统手术需要一个长的外侧弧形切口，这种方法会导致外侧软组织损伤（发生率高达24%）。
一名50岁女性在街头行走时脚踝扭伤1个月后，后足外侧出现疼痛。先前的治疗包括使用抗炎药物、冰敷、休息以及佩戴卡姆步行靴。体格检查时，腓骨肌腱走行处有疼痛和肿胀。排除了踝关节不稳和高弓足畸形。外翻力量较弱（4/5）。影像学检查显示腓骨长肌腱完全断裂，伴有尖锐的腓骨结节肥大。保守治疗（物理治疗、休息、止痛药物和踝关节稳定器）失败后，进行了手术修复。采用了一种侵入性较小的方法进行腓骨长肌腱清创，并将其与相邻的腓骨短肌腱进行端端吻合，临床和功能结果均成功。
腓骨长肌腱吻合术可通过一种侵入性较小的方法进行，同时保留外侧软组织的完整性。
