Article Figures & Data
Figures
- Figure 1.
Oblique radiograph showing widening of the lateral talotibial joint (arrows), suggesting some lateral ligamentous instability.
- Figure 2.
Proton density–weighted axial magnetic resonance image demonstrating one of the appearances of a split peroneus brevis tendon splayed over the normal-appearing peroneus longus tendon. Here, the peroneal brevis tendon was flattened and borders both the medial and lateral aspects of the peroneal longus, consistent with a split tendon.
- Figure 3.
Algorithm for the management and treatment of suspected split peroneal brevis tendon.
- Figure 4.
The anterior drawer test (A) and talar tilt test (B) assess injury to the anterior talofibular ligament. A: With the patient in the sitting position and the knee flexed, the examiner stabilizes the distal leg with one hand while cupping the other hand around the ankle and applying force, moving the talus anteriorly. If ligament laxity is noted, the test is positive, consistent with rupture of the anterior talofibular ligament. The examiner must compare both ankles. B: With the patient in the sitting position and the ankle in plantar flexion, the examiner stabilizes the distal leg with one hand while applying force to the hindfoot with the other hand, slowly inverting the foot. If ligament laxity and pain is noted, the test is positive, consistent with an anterior talofibular ligament tear.
- Figure 5.
Ottawa ankle rules are useful to assess whether radiographs are warranted: pain in the mid-foot zone and any one of the following: bony tenderness at base of the fifth metatarsal, or bony tenderness at navicular bone, or inability to bear weight in emergency department for 4 steps; or pain in the malleolar zone and any one of the following: bony tenderness along the distal 6 cm of the posterior edge of the tibia or tip of medial malleolus or bony tenderness along the distal 6 cm of posterior edge of the fibula or the tip of lateral malleolus or an inability to bear weight in the emergency department for 4 steps.
Tables
Grade of Split Description Magnetic Resonance Imaging Findings Treatment I Splayed-out tendon The peroneus brevis tendon is flattened between the peroneus longus tendon and lateral malleolus. Conservative treatment II Partial-thickness split The tendon is flattened and also shows central thinning and some degeneration of tendon structure. Conservative treatment III Full-thickness split The tendon had a central “fenestration” and appeared to be separated into 2 fragments on a variable of section. Surgical evaluation and repair IV Split extending >2 cm The tendon had a central “fenestration” and appeared to be separated into 2 fragments on a variable of section. Surgical evaluation and repair
