2cm longitudinal peroneal brevis tendon split

by Samantha
(Michigan)

I underwent an MRI that depicted "an approximately 2cm nonretracted longitudinal split tear involving the distal peroneus brevis tendon with associated mild common peroneal tenosynovitis. My doctor pretty much told me surgery is my only option since the split is so long. Is that true or would you recommend trying a non-weight bearing cast first?

RESPONSE

Hi Samantha,

This type of problem is seen quite frequently, where there is trauma to a tendon that essentially results in a partial tear. Because it is not totally torn you have a choice between surgery or immobilization.

I wish I knew more about you in terms of any medical issues you may have, are you a smoker, how old are you, etc., simply because those factors would go into the decision process. For the sake of this discussion I am going to assume you are under forty years of age and in reasonably good health and not overweight, nor are you a smoker.

If you have an occupation where you are on your feet quite a bit and are required to do a lot of walking, or if you are a serious athlete where you want to get back to your sport quickly and don't have to worry about the tendon again, then surgery would be your best option, simply because under an ideal set of circumstances, you will heal more quickly and the repair to the torn tendon will be stronger.

If your life style does not fit the above scenario then you could go into a non-weightbearing cast possibly for as long as six weeks and allow the tendon to heal. Assuming you are in good health (as defined above) there is a good chance the tendon tear will heal. You could also supplement your care with physical therapy.

Here is the problem.

What if you go six weeks in a cast and also have physical therapy and the tear does not heal? You have now "wasted' six weeks of your life and you are still faced with surgery. There is also the issue of compliance. Going non-weightbearing for six weeks is something you have to do 24/7, you cannot pick and choose when you want to do it. Should you "cheat" and you further tear the tendon, or worse, shred the tendon, then you are faced with a slightly tougher surgery.

That is the dilemma that you face.

In general terms, if you lead a sedentary life, and being on your feet all day or playing an active sport is not "you" then you could try the cast. If the opposite is true and you would like to get back to your life quickly, then you should consider the surgery.

I would also like to mention that if the tear is very close to where the tendon inserts into bone, there is a greater chance of total rupture, whereas, if it is away somewhat from the bone and you stay non-weightbearing, you stand a better chance for success.

I would also mention just for the sake of completeness, that I am not too concerned about your tenosynovitis as that should heal in either scenario.

Probably the best advice I could give you, from the other side of the internet, would be to get a second opinion from another doctor in your area. This is certainly one of those medical conditions where there are options available to you and you have to choose the one that best fits your needs.

Marc Mitnick DPM
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