Peroneal Tendon Surgery Guide

Always Try All Conservative Treatment First

Only when conservative treatment of the peroneal tendons fails would surgery be indicated.  Use the link above to learn about the most effective conservative treatments for peroneal tendonitis and other peroneal tendon conditions. Conservative treatment is effective over 95% of the time.  

Surgery for peroneal tendonitis can be difficult, with a long recovery period requiring significant rest and physical therapy. 

If You Have Exhausted Conservative Treatment for Peroneal Tendon Pain

If you’ve been told that you need surgery, and you’d like a second opinion, please make an appointment with us at the Foot and Ankle Center of Washington and we’ll evaluate whether or not you are a good surgical candidate. 

Peroneal Surgery can be tricky, and it’s important to find a surgeon with extensive experience in sports medicine surgery to perform the peroneal tendon surgery. At the Foot and Ankle Center of Washington in Seattle we have over 30 years of experience performing peroneal tendon surgery for severe cases of peroneal tendonitis. 

Am I a good surgical candidate?

A good candidate for surgery is someone who has exhausted peroneal tendonitis conservative treatment for at least 4 – 6 months with no improvement. All doctors use a slightly different variation of the treatments laid out on our conservative treatment page.

Even if you’ve tried a different doctor’s conservative treatment plan and been told you need surgery, we may want you to try our conservative treatment plan before we proceed to surgery. 

 You may need to optimize several parts of your diet and lifestyle before your surgery in order to be fully prepared for the next step. Be sure to see our Pre Surgical Planning page for more details on preparing for your surgery and recovery. 

What happens during the surgery?

  • An incision will be made on the outside of the ankle behind the ankle bone. The incision may be curved following the course of the peroneal tendons. 
  • Your surgeon will carefully dissect down to the peroneal tendons avoiding the sural nerve, open up the protective covering over the tendons and inspect them to see the damage. 
    • Most of the time the damage to the peroneal tendons is very clear, the tendons may be extremely weak and thin in some areas, or thickened with scar tissue in other areas. 
    • Just because your peroneal tendons are thickened, doesn’t mean they are stronger. Actually, the scar tissue weakens the tendon because it is disorganized and not useful tendon tissue. 
  • Once your surgeon sees the damaged tissue, they will “clean out” areas of inflammation, and repair your peroneal tendon with a special sewing technique and very strong suture/sewing thread. 
  • Sometimes it’s necessary to strengthen a damaged tendon by adding a special type of graft material, which can be wrapped around the tendon to protect it. If this is necessary, your surgeon will tell you far in advance of your surgery. 
  • There are two peroneal tendons, in very rare cases one of your tendons may be so weak that your surgeon must sew them together to strengthen them. In this case they will permanently function as one tendon. You’ll notice some changes in the way you walk, and it may take a few months of physical therapy to recover completely. 
    • It’s difficult to tell what is happening inside your tendons by a physical exam and x-rays alone, this is why a pre-operative MRI may be utilized if your surgeon suspects this is the case. 
  • Once the tendon (s) are repaired, your surgeon will close the skin with stitches and place a bandage over the surgical site. You will be placed in a custom made postoperative splint, so that you can not move your ankle and damage the tendons as they recover. 


How long does the surgery take?

This can vary depending on what additional procedures you need done, but most peroneal tendon surgeries take between 1 and 2 hours. 

Will the surgery hurt?

While all surgery comes with the risk of causing pain your doctor can help you manage your peroneal tendon surgery pain with a custom built pain management plan. We have over 20 years of experience with this surgery and that allows us to better predict the amount of pain typical after surgery. 

 The best way to avoid pain is by following your doctors postoperative instructions which includes resting, icing, and elevating the leg and taking the correct dose of medication at the correct time.

 You will not feel any pain during the operation, and for several hours following the surgery due to the local anesthetic that is placed around the surgical site. After the surgery you will start a treatment plan to avoid pain, and minimize pain in every way possible. With close adherence to this plan, most people feel very little pain in the weeks following surgery. 

Physical therapy that may be prescribed to help you get back to your normal daily activities can be uncomfortable. You will work with your surgeon and physical therapist to determine exactly how aggressive you should be with this physical therapy. 

Will I need a cast after peroneal tendon surgery?

You will not need a traditional plaster cast for peroneal tendon surgery. You will however be placed in a postoperative splint, which has a mix of rigid and soft support for the first week after surgery. You will then be transitioned to a removable below knee boot. You can’t get the cast, or the surgical site wet for several weeks after surgery, so you should buy a cast cover to keep it dry in the shower or when it rains. 

Will I need crutches or a knee scooter after surgery?

Yes, Definitely. You can’t put weight on the surgical foot for several weeks after surgery, crutches or a knee scooter will help with this. 

How long until I can walk after the surgery?

Peroneal Tendon Surgery can take a significant amount of time to recover from. Tendons are one of the slowest tissues in the body to heal. You will transition from placing no weight on the foot, to gradually increasing weight bearing over a period of 1-2 months. 

You will need to wear a surgical boot for several weeks after surgery. During this time you may not be able to drive. 

You may need physical therapy, prescribed by your surgeon to mobilize your tendons and prevent scar tissue formation. 

Returning to normal activity including walking, running and jumping may take up to a year after surgery. 

How long until I can play sports after surgery?

Depending on the course of your healing, it may take 6 months to a year to return to full sports activity. This is dependent on the exact quality of your peroneal tendons, procedures performed, and how well you follow your doctor’s orders after surgery. 

Will I need another surgery?

Even after surgery there is a very small risk that your tendons may have excessive scar tissue limiting motion or may rupture. We do everything possible to avoid these risks, and the need for another operation. All activities like resting, keeping weight off of the leg, and physical therapy are carefully prescribed to minimize your risk needing another surgery. We don’t want you to need another surgery, but if you do, we’ll be there every step of the way to help guide you through it and prepare. 

What are the risks of peroneal tendon surgery?

In addition to the above mentioned risks, you can find a general list of surgical risks on our Pre-Surgical Planning page. 

If the tendons are sewn together because they are too weakened on their own, you may lose the function of one or both tendons. This means you may have decreased push-off strength when walking. 

I need peroneal tendon surgery, what do I do now?

If you’ve decided it’s time for a peroneal tendon surgery, we highly recommend you come in for an in person physical exam at our Seattle Clinic. We will discuss any questions or concerns you have and order any necessary tests.  

If you would like to discuss avoiding surgery, we can build a custom peroneal tendonitis management plan for you. 

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