The Relationship between Medial Longitudinal Arch and Peroneal Tubercle

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1 The Relationship between Medial Longitudinal Arch and Peroneal Tubercle -Anatomical Study- Department of Orthopaedic Surgery Kangwon National University Hospital Chuncheon, Republic of Korea Chang Hyun Ryu, Kye Yong Han, Kang Lee 1

2 The Relationship between Medial Longitudinal Arch and Peroneal Tubercle Presenter: Chang Hyun Ryu, M.D. My disclosure is in the Final AOFAS Mobile App. I have no potential conflicts with this presentation 2

3 Introduction Cause of lateral ankle pain Peroneal tendon problem Ankle instability Sinus tarsi syndrome Fracture Congenital anomaly Peroneal tubercle Prevalence : 24-99% Inferior peroneal retinaculum insertion Functioning as a fulcrum directing peronei distally Enlarged tubercle may be related with peroneal tendon pathology known to be associated with foot shape 3

4 Purpose To determine the relationship between longitudinal foot arch and shape of peroneal tubercle 4

5 Material & Method Total 81 ankles of 81 subjects M : F -> 49 : 32 Age : 52.7 (range: 18-58) Subjects were divided into cavovarus group(talus-first metatarsal angle > 7 ) and control group with standing lateral X-ray. Then each peroneal tubercle were evaluated with 3D CT data. Data was obtained from uninjured side of bilateral ankle CT in patients with ankle fracture under informed consent Exclusion Criteria Absent peroneal tubercle Radiographic sign of arthritis Congenital anomaly(ex. Coalition) Recurrent sprain history Past history of prolonged ankle pain 5

6 Materials & Methods CT scan with resolution of 0.5mm 3D Reconstruction using 3D reconstruction program 6

7 Measurements & Results 7

8 Measurements & Results Cavovarus group(n=33) Control group(n=48) p-value Anteroposterior length ± 1.41mm ± 1.34 mm 0.22 Mediolateral width (axial) Peroneal tubercle angle (axial) Peroneal tubercle height Mediolateral width (coronal) Peroneal tubercle angle (coronal) 4.2 ± 1.80 mm 2.1 ± 1.51 mm ± 7.78 degrees 7.3 ± 4.20 degrees ± 3.85 mm 6 ± 2.97 mm ± 2.20 mm 1.8 ± 1.13 mm ±5.20 degrees 4.0 ± 2.43 degrees

9 Discussion & Conclusion Study about enlarged peroneal tubercle not many Difficult to define peroneal tubercle size and shape with plain x-ray. Further evaluation(mri, CT) is mandatory for evaluation of peroneal tubercle Need to define the natural history of enlarged peroneal tubercle Repetitive irritation?? Congenital development?? Excision of peroneal tubercle No definition of excision range Requirement of peroneal tunnel disruption 9 Conclusion surgeons should be more aware of the association with peroneal tubercle as a potential source of pain when lateral ankle pain is present in patients with cavovarus deformity.

10 Reference 1. Bruce WD, Christofersen MR, Phillips DL. Stenosing tenosynovitis and impingement of the peroneal tendons associated with hypertrophy of the peroneal tubercle. Foot Ankle Int 1999;20-7: Hyer CF, Dawson JM, Philbin TM, Berlet GC, Lee TH. The peroneal tubercle: description, classification, and relevance to peroneus longus tendon pathology. Foot Ankle Int 2005;26-11: Ochoa LM, Banerjee R. Recurrent hypertrophic peroneal tubercle associated with peroneus brevis tendon tear. J Foot Ankle Surg 2007;46-5: Taki K, Yamazaki S, Majima T, Ohura H, Minami A. Bilateral stenosing tenosynovitis of the peroneus longus tendon associated with hypertrophied peroneal tubercle in a junior soccer player: a case report. Foot Ankle Int 2007;28-1: Boya H, Pinar H. Stenosing tenosynovitis of the peroneus brevis tendon associated with hypertrophy of the peroneal tubercle. J Foot Ankle Surg 2010;49-2: Heller E, Robinson D. Traumatic pathologies of the calcaneal peroneal tubercle. Foot (Edinb) 2010;20-2-3: El Rassi G, Kouvalchouk JF, McFarland E. Isolated dislocation of the peroneus longus tendon over the calcaneal tubercle in an ice skater: a case report. J Bone Joint Surg Am 2012;94-7:e43. 10

Surgical Treatment for Stenosing Peroneal Tenosynovitis

809077FAIXXX10.1177/1071100718809077Foot & Ankle InternationalWatson et al research-article2018 Article Surgical Treatment for Stenosing Peroneal Tenosynovitis Foot & Ankle International 1 5 The Author(s)