Challenge of the Week / Foot & Ankle / 08.21.20

You have been following a 35-year-old female patient who is a recreational runner for peroneal tendinopathy in the setting of an overt cavovarus foot. She has undergone extensive nonoperative management including immobilization, physical therapy, and custom orthotics. Her pain and limitations persist, and she is ready to proceed with surgery. Your operative plan should address which of the following?
    • Peroneal pathology via peroneal tendoscopy
    • Peroneal tendoscopy is useful for examining the tendons, performing debridement, and decompression of the groove. Tears are more difficult to address. Malalignment is not addressed with tendoscopy.

    • Peroneal pathology via open surgery
    • Peroneal tendon surgery alone may be met with recurrence.

    • Cavovarus realignment as well as the peroneal pathology
    • Operative intervention should address both the cavus and the tendon pathology. Coleman block testing will help to determine the treatment for the malalignment, specifically if the hindfoot varus is driven by forefoot cavus.

  • Cavovarus realignment
  • The peroneal tendons should be addressed directly. Cavovarus realignment is not likely to result in treatment of the tendon pathology.


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