Prevalence of Abnormal Ultrasound Findings in Asymptomatic Peroneal Tendons

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Background. The peroneus longus (PL) and peroneus brevis (PB) tendons comprise the lateral compartment of the leg and work to stabilize the foot during weight-bearing. Peroneal tendinopathy can precipitate persistent lateral ankle pain and induce substantial functional disability. The process by which peroneal pathology can progress to significant lateral ankle dysfunction is thought to stem from asymptomatic, subclinical peroneal tendinopathy. As such, there is substantial clinical benefit to identifying asymptomatic patients with this condition before it progresses to disability. Various ultrasound (US) characteristics have been observed in peroneal tendinopathy. The purpose of this study is to identify the frequency of subclinical tendinopathic characteristics in asymptomatic peroneal tendons. Methods. A total of 170 participants underwent bilateral US examination of the foot and ankle. These images were assessed for abnormalities of the PL and PB tendons by a group of physicians, and frequencies of abnormalities were recorded. This team consisted of an orthopedic surgeon specializing in foot and ankle surgery, a fifth-year orthopedic surgery resident, and a family medicine physician with musculoskeletal sonographer certification. Results. 340 PL and 340 PB tendons were assessed. Of these, 68 (20%) PL and 41 (12.1%) PB tendons had abnormal traits. Specifically, 24 PLs (7.1%) and 22 PBs (6.5%) had circumferential fluid, 16 PLs (4.7%) and 9 PBs (2.6%) had noncircumferential fluid, 27 PLs (7.9%) and 6 PBs (1.8%) had thickening, 36 PLs (10.6%) and 12 PBs (3.5%) had heterogenicity, 10 PLs (2.9%) and 2 PBs (0.6%) had hyperemia, and 1 PL (0.3%) had calcification. Conclusion. Of the 170 participants, 34% had at least one abnormal PL characteristic identified on US. Twenty-two percent of participants were found to have at least one abnormal PB trait. In the study population, heterogenicity was the most prevalent abnormality found in PL tendons, while circumferential fluid was the most common abnormal trait in PB tendons. Understanding the frequency of abnormalities in asymptomatic peroneal tendons may aid clinicians in identifying subclinical tendinopathy before it progresses to dysfunction.