What is the functional anatomy relevant to understanding peroneal tendon syndromes?

Updated: Mar 07, 2018
  • Author: Steven J Karageanes, DO, FAOASM; Chief Editor: Craig C Young, MD  more...
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The peroneal tendons originate in the lateral compartment of the leg. The peroneus longus originates from the head and proximal two thirds of the fibula, whereas the peroneus brevis originates from the distal two thirds of the fibula. Both tendons have a musculotendinous portion that courses just below the lateral malleolus.

At the posterior aspect of the lateral malleolus, the peroneal tendons lie within the fibular groove, with the peroneus brevis medial and anterior to the peroneus longus. The fibular groove forms the anterior border of the fibro-osseous tunnel that the peroneal tendons course through. The inferior retinaculum and the calcaneofibular ligament form the posterior border.

The posterior talofibular and the calcaneofibular ligaments form the medial border. The superior retinaculum forms the lateral border. Just inferior to the lateral malleolus, the peroneus brevis courses anteriorly, crossing over the cuboid to insert on the fifth metatarsal styloid. (See the following image.)

Lateral ankle anatomy demonstrates the peroneal te Lateral ankle anatomy demonstrates the peroneal tendons as they course beneath the superior retinaculum. The anterior talofibular, calcaneofibular, and posterior talofibular ligaments are also shown.

Inferior to the peroneus brevis, the peroneus longus turns beneath the cuboid in a tunnel formed by the long plantar ligament and the groove of the cuboid. It then courses to insert onto the first metatarsal and medial cuneiform. In 20% of the population, an os peroneum may be present within the peroneus longus tendon as it turns under the cuboid bone. In 0.1% of the population, a structure known as the os vesalianum—a sesamoid bone—is found at the insertion of the peroneus brevis tendon.

A common variant in anatomy—the peroneus quartus muscle—occurs in approximately 6.6% of the population. Although the muscle may have a number of different attachments, it most commonly arises from the peroneus brevis muscle and is inserted into the retrotrochlear eminence of the calcaneus.

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