Peroneal Tendon Rupture Repair?

[Snugglerug]

I have a peroneal tendon rupture in my right ankle, which a surgeon has recommended for surgery. Apparently it’s not something that will heal on its own. I’ve been putting it off due to other issues (work, getting ready to move across country.)

In the meantime, I’ve been riding in MDC Ultimate Stirrups adjusted to 90 degrees, because as long as my ankle is kept straight, it’s not painful. But the twisting motion to pick up a regular stirrup after mounting–not so fun.

Has anyone experience this surgery, and if so how long before you were riding at 100% again? (I do dressage and low-level jumping.) The surgeon has said I’d be back to normal activity in 2 months. One week on crutches, followed by about 6 weeks in a walking boot. Any chance I can ride in the boot as long as I ride without stirrups? Or at least without my right one?

[Renn_aissance]

No comment on the surgery- which may be in my future as well- although I wish you the best of luck. You can indeed ride with a walking boot. I’ve done so with a broken foot. The pressure of the boot against the inside of your leg can get a little uncomfortable though.

[Snugglerug]

Thank you–that is encouraging!

[mustangtrailrider]

It’s funny, I had my Peroneal Tendon, at least part of it, removed to stabilize my anke. It was harvested to use as a ligament in my ankle joint itself. Pretty cool procedure and recovery was not fun. My ankle is very stiff and does not have much range of motion!

I was in a cast for 3 months and in PT for another 3 months.

I didn’t ride at the time, but I couldn’t have. I can’t imagine you would be able to ride in a walking boot…

Either way, good luck. Hope ankle heals well.

[Snugglerug]

Thanks for your input! I’m hoping I retain full range of motion–sounds like your procedure was more complicated than mine. They’ll just be debriding (sp?) the tendon itself. But like you, ankle stability is a big problem.

But now I need someone to break the tie! Will I be able to ride in a walking boot or not? Does it depend on the specific type of boot?

[medical_mike]

A close idea…

My first suggestion is search pubmed.com with said surgery name and read the abstracts…

Closest in my experience is a stabilization procedure. You made the comment about a debridement…that is a very different animal so I’ll go with the “what if” should they find something different when they open you up…

There is some loss of “plantar flexion/eversion strength”, which in the system of riding would bias you toward, heels down (which you are doing and should continue to do so after surgery) and ankle roll out. A good stiff boot and regular off horse balance/strength training should also help minimize.

Your rehab professional should be able to help you establish a sufficient program.

On horse consideration…
Wider stirrup with a cavalry foot position.

Outside branch of the stirrup going back or no worse than straight out from the horse.

Horse should be narrow…Meaning when sitting on your saddle that is on the horse, your hips should be no wider than say 25 degrees abducted.

Let your toes point out to where your hips put them. If they are at 10/2 for example, let them stay there. Turning them forward and or doing something that precipitates the sole of the foot turning up should be avoided.

No knee blocks, don’t want to promote knee gripping.

The time frame is generic. I would want to know how aggressive he will let the therapist be while you are in the boot. If he says straight from the boot to riding…weeeeeell, from a load perspective, IMO, that would be tough.

Now I would advise talking with your physician about getting on no stirrups…Remember it is not the riding that is the problem, it is hitting the ground in the event of a what if that creates the problem…Risk vs. Reward

Regards,
Medical Mike
Equestrian Medical Researcher
www.equicision.com

[Snugglerug]

Mike, thank you so much! That is really solid information.

I have been riding in my tall boots every day rather than half chaps for stabilization. Hard on the boots, but better than not riding at all! I am also restarting balance/strength training. Took a little time off because I had reached a point of constant pain with the ankle. Also ditched the high heels for work, which seems to have helped as much as anything.

You make a good point about the toes. I think that trying to force them to turn out further than is natural for me contributed to the problem initially. My doctor also said that I am prone to the problem due to very high arches.

It’s my understanding that I would be doing therapy pretty aggressively while in the boot. Doc did say that time frame depended on the person, but he thought for me (in good shape otherwise, and motivated to work hard at rehab) the process should be on the shorter end.

Of course, since I’m moving halfway across the country prior to surgery, I’ll have to find a new surgeon, which forces a 2nd opinion, which isn’t a bad thing at all.

Thank you again Mike!

[Coreene]

Welcome to my current reality.

On 11/26 I had total dislocation of my right knee, and LCL, ACL and PCL were trashed. At that second I also had peroneal nerve damage and now have drop foot.

On 12/2 they did LCL repair. Everything had come off the tibia, so they used cadaver and attached my ligaments to that, plus he cleared scar tissue around peroneal nerve.

On 12/2 I could not feel a thing. Since then, feeling has slowly been returning, and I can just barely begin moving the small toe and “ring” toe.

The spasms are all in the areas where I have no feeling, and the feeling is coming back. The doctor is optimistic that at least some movement will come back, which is good because I do not relish spending the rest of my life wearing a brace for foot drop.

Yesterday they repaired and rebuilt the ACL and PCL with cadaver and my own ligaments.

For the next eight weeks the right leg must be non weight-bearing, and no driving for 3-4 months.

Not how I had expected to spend Thanksgiving / Christmas / New Years / Valentine’s Day / St Pat’s / etc., but everything happens for a reason and I am sure I will figure out that the reason for this is too :sadsmile:

OP, good luck to you with yours!

[Snugglerug]

Yowsa!! :eek: Coreene, that sounds awful! I hope you’re doing better soon. No driving for 3-4 months?? I’d be in a rubber room for sure.

I think I’ll just concentrate on being happy that my injury is relatively mild!

[Coreene]

Snuggle, just wanted to share that tonight I could move my right (drop) foot outwards an inch, and outwards is the paralyzed direction.

No upward yet, but since surgery one was only three weeks ago this Friday, I am SO encouraged!

[Snugglerug]

[QUOTE=Coreene;6034393]
Snuggle, just wanted to share that tonight I could move my right (drop) foot outwards an inch, and outwards is the paralyzed direction.

No upward yet, but since surgery one was only three weeks ago this Friday, I am SO encouraged![/QUOTE]

Great news! I hope you get continued improvement.

[White_Horse]

Snugglerug,

I had my peroneal tendon repaired in my right ankle back on Dec 13th. I had a 3/4 inch tear in the peroneaus brevis branch (sp?) and a 1/4 inch tear in the peroneaus longus branch (sp?). I’ve been in a walking boot since the surgery. Stitches were in for 2 weeks. The first 4 weeks post surgery I was on crutches. The next 2 weeks I’m allowed to put weight on the foot but it is still in the walking boot. I’m scheduled to see the doc again Jan 19th (approx 6 weeks post surgery) and am supposed to come out of the boot then and go into a more traditional ankle brace. At that point I start 6 weeks of physical therapy. Once that is done if everything goes according to plan I’ll be cleared to ride again from what my doc says.

The worst part for me was about a week to 10 days after surgery. All the wrapping they put on post surgery was on there and getting irritating. If you’ve every had a cast on this was the same thing. It felt a lot better once they took the wrapping off and removed the stitches. Of course being on crutches for 4 weeks wasn’t pleasant either.

I myself wouldn’t try to ride in the walking boot I’m in. There are a couple of different styles I think but the one I’m in is bulky and heavy. It looks like this boot: Google Image of Similar Walking Boot It definitely wouldn’t fit in a stirrup and I wouldn’t feel comfortable going no stirrup with it on.

[Milocalwinnings]

I didn’t have a full rupture but had a tear in my Peroneal Tendon. My recovery time may have been different than what yours will be though because I had a complete lateral ankle reconstruction.

I was in a cast for a week I think and then a walking boot for 2 months (but was still non weight bearing for part of that time). I was on crutches for probably about 4 weeks and then walking in the walking boot for another 4 or 5. My ROM after surgery was terrible (and I had bad ROM to start out with). I made sure to gently stretch well before riding. I found doing two-point really bothered my ankle as it would feel like it was locking up and collapsing in. 2 weeks after I began riding again I ruptured four of my extensor tendons so it was right back to surgery.

As far as pain level, I had 4 surgeries on that ankle with-in 11 months and it was by far the most painful. Just make sure to stay on top of your pain meds and once you start PT make sure you stick with the exercises as they will really help your ROM and strength.

[mickeydoodle]

hmmmm, ortho foot and ankle surgeon here- my post op regimen is stricter, 6 weeks non weight bearing in a cast, then a walking boot and physical therapy 6 weeks, I would not recommend that patients ride until 12 weeks. Riding puts stress on the peroneals, and the repair is really not “solid” for more than 12 weeks.

On the other hand, just because there is a “tear” on the MRI (actually longitudinal splits, rarely a complete transverse tear) does not mean surgery is inevitable- patients can improve and get back to their sport with conservative treatment.

Wise to get more than one opinion.

I would suggest searching an Ortho Foot and Ankle doc on aofas.org, in the area you end up. (aofas= Am. Orthop. Foot and Ankle Society- members are board certified and more than 50% of their practice is foot and ankle)

[nashgirl]

Spring of 2010 I split my right peroneaus brevis almost right down the middle of the ligament, I think about 6 inches. (I also had tears in the other neighboring ligaments, but none requiring surgery.) The larger part was trashed and was removed, so now I have about 40% of the ligament. I was able to start PT prior to surgery, and started back with PT about 6 weeks after surgery but was allowed to start some simple exercises a couple weeks after the surgery. Although I was threatened with a cast, I was able to stay in the removable boot the whole time. I was non weight bearing for about 6 weeks, I think. Then in the boot for another 4 or so. My transition out of the boot was gradual. I was on my horses about 8 weeks after surgery, just walking, but thinking back on this it was too soon. I was pretty much back up to speed at about 12 weeks. My surgeon is terrific and only does ankles and some feet. He showed me a lovely picture of what my ligaments looked like once he accessed them, I think the picture was meant to scare me straight! My ankle feels a little tight sometimes, and I am very careful about my shoe selection. I’ve used the MDC stirrups at 90 degrees for a long time and I think they help. Good luck!

[Pcostx]

Having surgery on my right ankle tomorrow for a Peroneal tendon tear!

Also having my knees injected while I’m under because at 45 yrs. of age I was just diagnosed with having “substantial” (Docs word) arthritis in my knees! UGH!

Wish me luck!!

[Pcostx]

Home from surgery in a cast with my pain drip at the site of the surgery.

So far so good! Pain is NOTHING like what I’d expected after reading other folks experiences.

I’m in a cast for 2-weeks now!

It will be a LOOONG time before I know if the surgery worked for me.

[Coreene]

Sidebar on the Peroneal Nerve Ordeal. Even though it’s repairing downwards at 1mm per day from the knee, something is starting to fire up. The PT stretching of the foot is certainly helping it move more - what a relief! I’ll have to be wearing a brace for drop foot for months, but looks like that nerve will at least partly recover from being hyper-stretched. :sadsmile:

Good luck everyone, here’s to pain free movement!

[Leroy_Brown]

I found this post and wanted to ask how the folks who had the surgery are doing now. I have a tear of the peroneal tendon with sublaxation. Have been advised to do surgery with a lengthy recovery period, but am scared to do it in case things get worse not better. I really want to go back to riding and jumping, but ankle is very painful with too much stress on it. If you could share your experiences post op that would be great, especially to hear from a rider’s perspective.

Thanks so much.

[White_Horse]

Trying to ride prior to surgery it would feel like the outside of my leg just aobve my ankle was on fire. I couldn’t put any weight into my heel on that leg. Had surgery Dec 13, 2011, no weight for 4 weeks, walking boot for another 2, more of a regular ankle brace for another 4 and started physical therapy at that point. Started physical therapy at the beginning of February. Was released from physical therapy and given the ok to return to normal activity at the beginning of April (so approx 4 months post surgery). While I was cleared to return to riding at that point I didn’t feel the ankle was quite ready yet as it would get tired quickly still. I took another month of doing exercises on my own before riding again. So I started riding again mid-May (approx. 5 months post surgery). The ankle now has never felt better. I make sure I stretch it before I ride and do wrap it with vet wrap for support while riding. There are sometimes that I will need to take my feet out of the stirrups and stretch it while riding but overall the ankle feels great and hasn’t been a problem while riding. Definitely don’t have the pain like I was before. My instructor is amazed because she’s usually telling me that the side I had surgery on looks better (in terms of heels down, etc) than the side that wasn’t operated on.

Now I had my right ankle repaired, had it been my left I probably would have been out from riding a little bit longer because at the point I returned I don’t know that I would have been confident in it to mount yet off that leg.