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Musculoskeletal Imaging

E2879. Imaging of Common Peroneal Tendon Abnormalities

Essenmacher A,  El-Khoury G. University of Iowa Hospitals and Clinics, Iowa City, IA

Address correspondence to A. Essenmacher (

Background Information: A variety of abnormalities affect the lateral ankle, particularly the peroneal tendons, and this is a frequent indication for imaging of the ankle. Radiologists should be familiar with the anatomy and abnormalities that can involve the peroneal tendons, retinacula, and related osseous structures. A range of acute and chronic injuries have the potential for considerable abnormality, and the radiologist must recognize these. This exhibit covers lateral ankle abnormalities that a radiologist can encounter in daily practice.

Educational Goals/Teaching Points: Teaching points of this exhibit include identification of the origin, course, and insertion of the peroneal tendons. Vigorous physical activity can lead to partial tendon tearing, and the peroneus longus tendon is particularly susceptible. Signs of tendinosis include thickening and heterogeneously increased signal intensity on T1- and T2-weighted images. If severe enough, complete rupture may occur. This will manifest as a wavy or discontinuous tendon.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: Certain anatomic variations can make a patient more predisposed to development of lateral ankle tendon injury. These include a prominent peroneal tubercle of the calcaneus, which leads to peroneus longus tendinosis, and a low-lying peroneus brevis muscle. Other variant muscular anatomy includes the peroneus quartus. This can be without clinical significance or predispose a patient to tendinosis, tenosynovitis, or stenosis.

Conclusion: This exhibit will provide the viewer with an overview of tendinous and osseous anatomy of the lateral ankle and abnormalities involving this region. Acute and chronic ankle problems are a common cause for imaging, and tendinosis and tenosynovitis as well as variant anatomy should be recognized.