Peroneal Tenography to Evaluate Lateral Hindfoot Pain after Calcaneal Fracture

Abstract

Lateral hindfoot pain after union of a calcaneal fracture remains a challenge to orthopaedic surgeons. This study aimed to investigate the relationship between lateral calcaneal pain, calcaneal width and peroneal tendon sheath impingement in patients with lateral hindfoot pain. Seventy-four consecutive patients with unilateral lateral hindfoot pain were identified from an institutional trauma registry. Regular followups were performed and the severity of lateral hindfoot pain was recorded. CT scans were conducted to measure calcaneal width at the level of sustentaculum tali. Bilateral peroneal tenography was performed to examine compression of the peroneal tendon sheath. The sheaths on the injured, painful side were compared to the contralateral sheath at the same level. The data was analyzed with bivariate correlation using SPSS 13.0 for Windows. The injured calcanei were wider in all patients and the peroneus longus and brevis tendon sheaths were compressed on peroneal tenography in 68.9% (51 of 74). Statistics demonstrated significant correlations between compression of tendon sheaths and lateral hindfoot pain (Rs = 0.93, p < 0.001), and between increasing calcaneal width and lateral hindfoot pain (Rs = 0.665, p < 0.001). The severity of lateral hindfoot pain was directly correlated to tendon sheath impingement and indirectly related to calcaneal widening. Calcaneal widening following fracture union was the cause of compression of the peroneal tendons. Increasing compression correlated with increasing levels of lateral pain. Our study demonstrated the utility of peroneal tenography in identifying the presence of peroneal tendon impingement in patients with lateral pain following calcaneal fractures.