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Is surgery necessary for a split tear of the peroneus brevis tendon?

Discussion in 'Ask your questions here' started by Unregistered, Apr 30, 2011.

  1. Unregistered

    Unregistered Guest


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    I had surgery in June for multiple tears in my Brevis Tendon related to degenerative processes. I am 35 and my doc told me that he was suprised to see the damage I had. In Oct I had a complete rupture of my plantar fascia on my L foot. A couple of months after this I was having a lot of lateral column pain and lateral ankle pain on my lft foot. My podiatrist at that time would just blow me off when I would bring it up. I ended up switching podiatrist. He had order an MRI which showed the tear, but when he got in there it was worse than he thought so he had to repair the tears and then attached the brevis tendon to the longus tendon. I was in hard cast for a week then camboot for 2 weeks with non-weight bearing. Then camboot for 4 wks after that. I still have pain in my L ankle and swelling. I cannot walk on uneven surfaces if so I cannot walk. I am a nurse and had went back to work after 3 weeks, which sucks since I am on my feet a lot. I would like to know if other people about 8 wks out still have increased pain and swelling.

    Thanks
    Tam
     
  2. Doug

    Doug Guest

    Finally was ordered to have surgery. August 17th is my date. I can't walk without pain with my boot. They cut my cast off last week and didn't put on a new one since I'm having surgery in less than 2 weeks. I'll part again after surgery. For anyone going through this, I can definitely tell you that you do need surgery! I originally ruptured my brevis tendon 6 years ago playing soccer. Had a combination of hard cats and walking boots for 6 months. 6 years later, it's happened again. I was told that if I would have had surgery the first time that this wouldnt have happened a 2nd time!
     
  3. grandma's foot

    grandma's foot New Member

    It sounds as if others share some of the frustration that I have in trying to obtain effective treatment for this tendon tear. I was initially diagnosed by MRI in Dec which was confirmed by dynamic ultrasound in Apr. It is now Aug and my ankle is no better having encountered numerous delays along the way and having received conflicting opinions as to whether such a tear ever heals on its own or whether surgery is always indicated. In attempt to "heal" this I wasted 3 mos awaiting Southwest brace to be made which still didn't properly fit after 3 molds had been done for which insurance was billed $4800! There were multiple delays from the manufacturer and I am befuddled as to why the certified "fitter" didn't take initiative to contact the surgeon re: need of interim plan instead of repeatedly telling me it'll be here "next wk". I called the surgeon's office and was improperly adviced by the front office staff to reschedule my appointment as I hadn't been wearing the brace. I am now in camwalker which so far has not made the ankle feel any better. I fail to understand why trying to obtain treatment is so difficult!
    I guess what I'd like to know is whether anyone has had successful surgical repair, as the process sounds daunting. Or if anyone has had a successful heal with immobilizing the ankle. Thank you.
     
  4. crconlee

    crconlee New Member

    I will tell you about my experience and maybe it will help you. Two years ago i awoke in the night with severe pain in my foot in front of the ankle bone. An x-ray showed nothing so they gave me a shot of anti-inflamatory medicine and sent me home. My husband was in home Hospice care so I manged through until his death. Since then I have been to 8 doctors, an MRI, CAT scan, 6 weeks in a knee high cast, three times in a soft cast, steroid shots and PT. Nothing helped. I finally searched the internet for the best foot and ankle specialist in the Chicago area. He ordered a muscular/skeletal ultrasound which finally showed the longitudinal tear in the brevis tendon.

    The doctor told me 50% of people could be helped by PT to have the other tendons learn to take over for the Brevis. He also said that if I had surgery it would be 6 weeks with not touching my foot on the ground at all. I went for PT and the therapist said he didn't think PT would work.

    I went back to my original foot and ankle specialist (orthopedic) and he concurred that pt would not fix it as none of the methods I had used before worked either. That surgery was the only fix, but that I would walk out of surgery in a soft cast.

    Now I don't know what to think. Surgery or not? Walk after surgery or not?
    So......I came to the internet to find out what I could find. My search has led me to believe that surgery is the only answer. I am still wondering about post op recovery. I am a 66 year old diabetic and I want this foot to heal the first time.
     
  5. crconlee

    crconlee New Member

    I will be anxious to hear about your surgery and how recovery goes for you. My prayers will be with you.
     
  6. Unregistered

    Unregistered Guest

    I am getting ready to have surgery done on my left foot for a tear in my brevis and longus tendons. I have been and a walking boot for two weeks now to see if that would work to heal it but it has not. So I have agreed to surgery before the problem gettings any worst. My doctor is not sure when I might have torn the tendons because I have been in pain for about ten years now and ever doctor I saw at first just blew me off. Than I feel again last month and the dostor believes that I causer more damage to the tendons because I am in alot more pain now. But I am not sure what to expect because it seems like everyones after surgery plan was different. Some of them got hard cast some only got the boot. Some people were in lots of pain and some were just fine. I just wanted to know if anyone else has had to have both tendons repaired at the same time like I do? Thank you!!!
     
  7. Unregistered

    Unregistered Guest

    Hi, I had surgery after 6 months of pain. That was june 2011. I have done all that was required of me by the physio's and more. However the surgery was not successful - the rate for success is 80% for 20% against. I now have the option to do nothing or to graft the Brevis onto the Longis. This also has the same success rate as my previous repair but holds further increased dangers as reguards to infections/thrombosus/pain etc. It is very dispiriting and involves 12 months of recovery to something like normal. I'm not sure as what to do? has anyone had a failed repair and what was the outcome?
     
  8. sjf

    sjf Guest

    Re: Had the tendon surgery this week

    Hi folks,
    I just had this surgery last week. I have a pic of the incision - not sure if I can post it here, will check after.

    My surgery went fine. They used skin grafts and sutures as well as using my own platelets spun from my blood taken on the day of surgery to transfuse into the area to help repair torn ligaments as well.

    I have a hard fiberglass cast that has already been changed because it was way too tight. Would you believe the second cast was wet when I got home all over the bottom and up the back? The doctor stated that the material used on the footing of the cast is wet by nature and to 'blow dry' it. Seriously? I did what they said but will call again tomorrow because I am worried about infection from a wet cast.

    I was told that I can bear weight right away and am using a walker. Pain is not too bad but trying to keep off my feet as much as possible. Stairs are a challenge. Anyone have any tips on how to deal with those?
     
  9. Unregistered

    Unregistered Guest

    Wow! I thought I was the only one...
    It is so hard to believe that so many people have the exact same problem. And yet so many varying opinions from doctors.
    I am trying to make sense of what to do next. I started having lateral foot pain in April. Went to doc, had MRI, found to have partial thickness, longitudinal split tears in the brevis and thickening, fraying, splaying of the longus.
    Wore cam boot and had PT for 6 weeks, no help. Now I have pain behind the ankle bone, achy, comes and goes depending on my activity level. Basically can't do much of anything without paying for it later. Got second opinion and he said no surgery, it was mild case. OK..... now what? So the 3rd guy wants to do cortisone injection.
    I am so confused. I think because they are partial thickness? Not as bad?
    Any suggestions from anyone?
     
  10. Unregistered

    Unregistered Guest

    I rolled my ankle in Aug of 2011. I thought it was just a sprain. After not getting better I had an MRI which showed a lateral tear of the peroneus brevis tendon. Since it had been 8 mos and it did not heal with time and booting, I decided to go ahead with the surgery as I could not handle walking carefully and hoping not to roll on my ankle causing pain anymore. I had the surgery April 26, 2012. I was in a half cast for 2 weeks and nonweight bearing. When the stitches came out at 2 weeks I got my "ironman" boot. I was then able to begin bearing weight using crutches, progressing to 1 crutch, and then progress to no crutches but continue with the boot and I also started Physical Therapy. I am not going to lie. I was in a lot of pain after the surgery. My foot had to constantly be propped up above my heart due to swelling. I used pain meds and ice. I used Ice even through the night for the pain. When my foot would hang down it would swell and throb. I heal very slowly in general. At 3 mos I was able to walk around at home with no brace at all and just a store bought ankle brace when out with a supportive sneaker. At 5 months I had progressed to being able to walk slowly on the treadmill for 30 min and I could do weight bearing exercises. I still experienced pain - but not the pain I experienced with the original tear, which was a sharp pain that would make me scream if I turned my ankle the wrong way. This was more of a "I need to give it a break and put it up" pain. I needed to continue gaining strength and endurance for sure. At 5 mos my PT recommended another 6-8 weeks of PT. I used Mederma as soon as my incision was completely healed and you can hardly see my 3 inch scar! The doctor said "If only the inside would heal as well as the outside!" Use Mederma. I scar like crazy. I believe the Mederma made a huge difference. Unfortunately, after 5 mos of progressing, allbeit slowly, I over did it one night while exercising. I had been out of PT for 1 month due to vacations. The following week I re-tore the same tendon in a different spot. All my 5 mos of work down the drain. I knew immediately what I had done. I recognize that pain! Even though I wondered if I was better off since at 5 mos I was still having difficulties - I know now that I was because I cannot handle standing there, not moving, and just lean over on my ankle or twist in just a way that I scream with pain! 2 weeks later I told the Dr I needed another MRI for a possible tear and he said "I'm sure you didn't tear it again". But then again - if its going to happen it happens to me so he agreed. Sure enough...it's torn. I just got the news on Monday. I cried for 2 days. I think I cried knowing what I have to go through all over again and how painful and difficult it is to be incapacitated for so long. Oh and yes it is my right foot. I have not driven in a year! I have to rely on everyone else and I live in a 2 story home making it very difficult to get up to bed at night if no one is here to help. I have a trip planned in 4 weeks to Vegas. Oh well - trying to think positive. At least I know its torn. The doctor put me back into a walking boot for a month and crutches if needed for long walks. Had I gone to Vegas with just my store bought brace not knowing it was torn and I positive I would have completely blown it out and ruined my trip. At least with the boot I am pretty confident I will not do any harm to it. I am going to bedazzle/bling out my boot and my crutches for Vegas! I see the doctor Oct 30 and we decide on surgery then....if it doesn't heal on its own which we all know it won't. I have been dealing with this now for 13 month and I am pretty down BUT its not the worst thing in the world. It's not cancer and we can all heal from this. It is not a death sentence just a major inconvenience. My PT told me that you need a high protein diet to help promote healing. I also take Vit D and Vit C to help. I will be buying some Calcium also to begin. My problem may be that I take inhaled corticosteroids to treat my asthma. But I have to breathe so.....I do it. My recovery as been 5 mos so far since surgery. Online it said 4-6 mos generally. I take about double so I think I was doing pretty well. Hang in there everyone! And DO NOT overdo it or you will wind up like me. Going back for Round 2!
     
  11. Unregistered

    Unregistered Guest

    To the above post going for the 3rd opinion. Hopefully you are seeing Orthopedic Surgeons. Find the best! Do not settle for less. My surgeon is a specialist in foot/leg for our Hockey team. So I know he nows how to patch those boys back up and get them back out on the ice! Good luck!

    Oh - and with my peroneal brevis tear I, too, get the pain back in my Achilles. Not fun...
     
  12. Unregistered

    Unregistered Guest

    Stairs - quite a challenge. I could not bear weight for the first 2 weeks. I would go down the stairs on my booty holding my foot up while dragging my crutches with me. Going up I drag the crutches up with me while I crawl on my knee. The dogs think I'm nuts lol.
     
  13. Unregistered

    Unregistered Guest

    Yes I have seen all OSs. That is why it is so difficult for me to understand why the opinions are so different. From everything I've read, if a tear doesn't heal with conservative treatment (which I've done) they will opt to fix it. Especially since i am an active person.
    I am scared, frustrated and annoyed. I want to be able to walk, hike, bike, run, etc... It hurts to do those things, but not everyday. If i rest it's fine, but i don't want to spend the rest of my life "resting". I am a young 42 and like to snowboard in the winter and hike, camp and be outside the rest of the year. I'm afraid to have the surgery and have them tell me nothing was wrong in there!!! Even though the MRI showed partial thickness tears, etc.
    In short, I just wish 1 dr. would be confident in his opinion to give me a straight answer. Right now I just am going to go with how my body feels and have it repaired.
    Wish me luck!!
     
  14. Unregistered

    Unregistered Guest

    I had surgery on 9/13/12 for a longitudinal split-tear of the peroneus brevis. Had the half cast for 2 weeks. Then suture removal and am in a plaster cast for 3 weeks. I am truly surprised at how much pain I am in at almost 4 weeks post-op. Percocet is helping along with elevation and ice. Not much swelling at when I got the half cast off. I alternate between a knee scooter and crutches. I am a pharmacist, so I am out of work right now. Going in on 10/18 for the next step. Had a tough time dealing with the lack of ability to do things around the house and yard. I love cutting the grass and got the riding lawn mower that is an automatic...dumb move since the surgery was on my right foot. Unable to drive as well. It's been 4 weeks (almost) with non-weight bearing. I'll keep you posted on the next step.
    I've also been to two NFL football games in a wheelchair. Can't keep me from that! I trust my surgeon completely. Interesting fact-I broke my fifth metatarsal at the base (where the tendon attaches) 3 years ago. I noticed that just behind and under the ankle would swell on occasion and especially after step aerobics class. I suspect the tendon was either injured or torn at the time of the break.
     
  15. Unregistered

    Unregistered Guest

    I was incorrectly diagnosed for a year (twice by sports med docs and once by a podiatrist) before I finally got someone to give me an MRI. It showed intermediate tears in both peroneal tendons, an extra foot bone and a lot of edema and scar tissue. He also had to mend two torn ligaments that didn't appear ripped on the MRI. I had surgery on 9/13/12. It took 3 hours and the doc had to stitch up both tendons, cut out the scar tissue and extra bone, as well as extra muscle that was blocking the area behind the ankle bone where the tendons run. My incision runs from the base of my foot to 1/4 of the way up my leg.

    I've been non-weight bearing for 4 weeks with two more to go. I had two hard casts over the last 4 weeks, and am in a boot now. My good leg has trouble doing too many stairs, and the good foot got sore from using the crutches, so I opted for a rental roll-a-bout. I recommend it if you need to go back to school or are going places with no stairs.

    Pain was manageable the whole time. Being useless getting around is the worst part for me. Water bottles frozen and placed under the knee are very helpful with pain and swelling. Oxycodone helped for the firt 7 days.

    My symptoms included heel, ankle and little toe pain that prevented me from running. Pt helped heel but nothing else. It gradually got worse. Podiatrist 1 took X-rays and found a toe fracture, but she excused the pain as tendonitis and just put me in a boot for 8 weeks. Four months later when I slowly returned to running, I had the same pain outside my ankle. Found good podiatrist who listened to my concerns. In addition to the pain it was growing unstable.

    After the sixth week of non-weight bearing I get to start putting 50 percent weight on it to see how it goes -- standing.

    The Dry, atrophied leg after the hard cast was pretty gross! I found it more ugly than the staples on my 9" incision. As annoying as this is, it's better than having it rupture! Good luck everyone.

    I'm an active 36 year old female. And my six year old hates my inability to move as much as I do. :)
     
    Last edited: Oct 12, 2012
  16. beckalea

    beckalea New Member

    I had surgery on 9/13/12 for a longitudinal split-tear of the peroneus brevis. Had the half cast for 2 weeks. Then suture removal and am in a plaster cast for 3 weeks. I am truly surprised at how much pain I am in at almost 4 weeks post-op. Percocet is helping along with elevation and ice. Not much swelling at when I got the half cast off. I alternate between a knee scooter and crutches. I am a pharmacist, so I am out of work right now. Going in on 10/18 for the next step. Had a tough time dealing with the lack of ability to do things around the house and yard. I love cutting the grass and got the riding lawn mower that is an automatic...dumb move since the surgery was on my right foot. Unable to drive as well. It's been 4 weeks (almost) with non-weight bearing. I'll keep you posted on the next step.
    I've also been to two NFL football games in a wheelchair. Can't keep me from that! I trust my surgeon completely. Interesting fact-I broke my fifth metatarsal at the base (where the tendon attaches) 3 years ago. I noticed that just behind and under the ankle would swell on occasion and especially after step aerobics class. I suspect the tendon was either injured or torn at the time of the break.
    New update. Went back to dr and am in a removable boot. Still non-weight bearing. I can only take the boot off to shower or bathe. Pain is worse now that the plaster cast is off. The incision looks like an "S" following the length of the tendon. Ankle is swollen. Next step is Physical therapy after a follow-up in two weeks. Will update after that. :(
     
  17. Unregistered

    Unregistered Guest

    Hi my symptoms a chronic swollen ankle I was refered by my PT for ultrasound guided aspiration and acorticosteroid injection which did sucessfully reduce swelling and fluid build up then i endured painfull PT for 5 months that did nothing but put a hole in my bank account. PT referred me to orthopedic surgeon i was sent for MIR which showed a large tear my surgeon informed me that my condition would require surgery to repair the tendon or possibly a tendon transfer post surgery a cast for 4 weeks then a cam boot for 8 weeks plus back to PT again. i put this surgery off for as long as i could and i made it to 2 years post diagnosis !! by then i could hardly walk 200 meters max!! and i was in a moderate amount of pain .. anyhow finally had my surgery 2 weeks ago i had a nerve block for the procedue other than that up to 4 endone5mg daily and i sleeping tablet every night today i was back for my post op appointment the half cast was removed ( thank god ) the cast was very uncomfortable and defiantly added to my pain, I was NWB for the last 15 days, I couldn't of asked for a better result the incision is about 10 cm long very clean and only slight swelling plus no brusing i didnot require a tendon transfer just repair of a large tear, I was expecting to go back into a cast instead I was put into a CAM boot I'm still using my crutches which I have to ween myself off over the next 4 weeks .. Mild to moderate pain but bareable ... Good luck to everyone undergoing or recovering from this operation .. BTW I had my operation in Sydney Australia
     
  18. jdonalds

    jdonalds Guest

    What if I elect not to have surgert

    I had a ladder collapse under me Oct 27, 2011. My feet were about 5' off the ground. I was on coumadin blood thinner so developed a hematoma in my left buttox which damaged 33" of my sciatic nerve in my left leg. The siatic nerve is healing, it is now more than a year since the ladder incident. Ten months after the ladder fall my brevis tendon parted, likely associated with the original fall but it went undiagnosed.

    I had surgery for the brevis tendon in August 2012 at which time the surgeon found it to be quite a mess behind my ankle. I went through about 9 weeks of recovery, then the tendon parted again. I'm scheduled for another surgery next Tuesday using a cadaver tendon.

    I had very little pain from the surgery, likely masked by my sciatic nerve pain. I'm already on pain meds for that and didn't have to do anything more following the surgery.

    The question is: if I don't have surgery and live with this parted tendon what will be the long term effects? My podiatrist said over time the left foot would turn in toward the right foot. Perhaps I can live with that. I'm 66 and don't expect to live beyond age 77 so only 11 more years. How long will it take for the foot to turn? How drastic will a turned foot be?
     
  19. Unregistered

    Unregistered Guest

    Had surgery to repair my lateral torn brevus. MRI showed
    4 in tear, she got in and it was 6. This was on 23rd.
    Non weight in jones cast 2 weeks. (Jones cast back part 1/2 cast
    Front thick bandages) that's off except for protection at night. Boot cast during day
    If moving around. (Which is impossible since my ankle
    Don't bend to fit it right) so mostly I'm immobile. Non weight 8-12 weeks pt starts at 5 weeks
    Pain 2-3 days but Tylenol and pain meds helped

    Can't believe your docs have you on boot walking so soon
    After surgery. That's crazy. Just wanted to chime in
    And tell you my surgery story. Going ok so far. No
    Work got a month. (I have a sitting job)
    Good luck everyone.
    Michelle
     
  20. Unregistered

    Unregistered Guest

    wow!! i just got my mri results with....:
    _other things also but,

    **split tear of Split tear of pernoneus brevis tedon (no mention of size/extent)

    was this a suprise to anyone when they were diagnosed with this? i only ask bc im wondering if it can 'slowly happen'(meaning a split tear) and if pain is not there at the time and injury occured.

    ive been walking on/with split tear for over a year since boot was removed from a fractured fibula.

    hurt really bad when i broke my fibula, now i just dont seem to have any muscle.. its a weak area.

    if i need surgery would it be possible that it is 'unfixable'. only ask this bc im still 2months out to see a specialist.

    thanks for any info and please comment.
     
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