Longitudinal Tears of Peroneus Longus and Brevis Tendons: A Gouty Infiltration

doi:10.1053/j.jfas.2011.06.004

The Journal of Foot and Ankle Surgery

Volume 50, Issue 6, November–December 2011, Pages 751-753

https://doi.org/10.1053/j.jfas.2011.06.004 Get rights and content

Abstract

The natural history of recurrent uric acid deposition includes joint destruction, as well as tendon weakening and rupture. Simultaneous rupture of the peroneus longus and brevis tendons secondary to tophaceous gout is very rare. In the present report, we describe the case of a 37-year-old man who had a history of recurrent ankle pain and 4 previous episodes of acute gout localized to his ipsilateral first metatarsophalangeal joint. The physical examination revealed the ankle pain to actually be localized to the peroneal tendons immediately distal to the fibular malleolar groove. Magnetic resonance imaging showed longitudinal tears in the peroneus longus and brevis. Surgical exploration and repair of the ruptured tendons revealed the presence of monosodium urate deposition within the substance of the tendons at the rupture sites. The tendons were debrided and repaired using longus to brevis tenodesis. The postoperative course was unremarkable and entailed referral to a rheumatologist for metabolic management. After more than a 1-year period of follow-up, the patient was ambulating without difficulties wearing regular shoe gear.

Section snippets

Case Report

A 37-year-old white man presented to our clinic with an approximately 5-year history of recurrent pain, redness, and swelling localized to the posterolateral aspect of his right ankle. The pain was aggravated by ambulation, particularly when he tried to run or play soccer. During the preceding year, his symptoms had worsened, the exacerbations had become much more frequent, and his everyday activities were inhibited by progressively more frequent ankle sprains secondary to inversion

Discussion

Extra-articular tophaceous gout, although not unheard of, is rare in the peroneal tendons. Persistent tophaceous gout is associated with chronic inflammation, which can lead to degeneration of the involved soft tissues and bone. When localized to a tendon, rupture can ensue, because the urate crystals have been shown to lead to a reduction in the tensile strength of the tendon 8, 9. The case we have described in the present report involved both the peroneus longus and the brevis tendons, and

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Cited by (17)

Peroneus brevis tendon injuries: Report of two cases and review of literature
2021, Trauma Case Reports
The incidence of peroneal tendon disorders in the population is unknown and they are usually overlooked. We report two cases of peroneus brevis injuries and a comprehensive literature review was performed. The first case was a 53-year-old man presented with persistent pain on the lateral aspect on the left ankle during the last four years and difficulty to bear weight during the last year. MRI showed longitudinal tear of peroneus brevis tendon and the patient underwent surgical treatment. The second case was a 46-year-old woman with persistent pain on the lateral aspect of the ankle with a history of a road traffic accident two years ago. Although MRI showed a peroneus brevis tendon tear, this was a false positive finding. Surgical treatment revealed no tear and symphysiolysis managed to relieve patient's symptoms. Even though MRI is the most effective diagnostic tool in depicting peroneal tendon injuries, there are false positive findings. In cases when symptoms persist, surgical exploration is indicated.
Foot and ankle muscle strength in people with gout: A two-arm cross-sectional study
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Citation Excerpt :
Eversion and inversion motions of the foot, which involve the peroneal and tibialis posterior muscles, are also important throughout the gait cycle, particularly for their contribution to shock absorption and stability (Louwerens et al., 1995). Although the impact that MSU deposition in these ankle structures has on muscle strength remains unclear, several case studies investigating tendon ruptures of the ankle and foot in the gout populations have suggested that the presence of tophi reduces the tensile capacity of tendons (Jerome et al., 2008; Lagoutaris et al., 2005; Radice et al., 2011). Furthermore, the infiltration of tophi into muscle tissues may potentially reduce the functional cross-sectional muscle area (i.e. area of active working muscle) and thereby the potential to generate force (Kao et al., 2012).
Foot and ankle structures are the most commonly affected in people with gout. However, the effect of gout on foot and ankle muscle strength is not well understood. The primary aim of this study was to determine whether differences exist in foot and ankle muscle strength for plantarflexion, dorsiflexion, inversion and eversion between people with gout and age- and sex-matched controls. The secondary aim was to determine whether foot and ankle muscle strength was correlated with foot pain and disability.
Peak isokinetic concentric muscle torque was measured for ankle plantarflexion, dorsiflexion, eversion and inversion in 20 participants with gout and 20 matched controls at two testing velocities (30°/s and 120°/s) using a Biodex dynamometer. Foot pain and disability was measured using the Manchester Foot Pain and Disability Index (MFPDI).
Participants with gout demonstrated reduced muscle strength at both the 30°/s and 120°/s testing velocities for plantarflexion, inversion and eversion (P < 0.05). People with gout also displayed a reduced plantarflexion-to-dorsiflexion strength ratio at both 30°/s and 120°/s (P < 0.05). Foot pain and disability was higher in people with gout (P < 0.0001) and MFPDI scores were inversely correlated with plantarflexion and inversion muscle strength at the 30°/s testing velocity, and plantarflexion, inversion and eversion muscle strength at the 120°/s testing velocity (all P < 0.05).
People with gout have reduced foot and ankle muscle strength and experience greater foot pain and disability compared to controls. Foot and ankle strength reductions are strongly associated with increased foot pain and disability in people with gout.
Structural joint damage in gout
2014, Rheumatic Disease Clinics of North America
Citation Excerpt :
Finally, a recent study using DECT in patients with tophaceous gout showed that 10.8% of tendon sites in the feet had MSU crystal deposition, with the Achilles tendon being the most commonly affected tendon of those assessed (see Fig. 1B, C).77 Although tendon damage is not as clinically apparent as cartilage and bone damage in patients with advanced gout, cases of tendon rupture that may have been associated with the presence of MSU crystals or tophi have been reported.78,79 Tophus infiltration into tendons has also been observed during surgery.80–82
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2022, Diagnostics
Shoulder gouty arthritis with tophus: a case report and literature review
2020, Chinese Journal of Orthopaedics

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Case Reports and SeriesLongitudinal Tears of Peroneus Longus and Brevis Tendons: A Gouty Infiltration

Abstract

Section snippets

Case Report

Discussion

J Foot Ankle Surg

J Foot Ankle Surg

Gout: diagnosis, pathogenesis, and clinical manifestations

Curr Opin Rheumatol

The management of gout

N Engl J Med

Case Reports and Series
Longitudinal Tears of Peroneus Longus and Brevis Tendons: A Gouty Infiltration