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Peroneus Brevis


- Anatomy:
    - origin: distal 2/3 of the lateral surface of the body of fibula and the adjacent intermuscular septa;
    - insertion: tuberosity on lateral side of proximal end of 5th metatarsal;
    - action:
          - plantar flexion and eversion of the foot at the ankle;
          - gives lateral stability to the ankle;
          - primarily active during the stance phase of gait;
    - nerve supply:
          - peroneal, S1 > L5, L4; (see innervation)
    - synergists: gastrocnemius, soleus, peroneus longus.

- Pathologic Conditions:
    - peroneal tendon disruption:
    - peroneus brevis tear:
          - longitudinal tears of the peroneus brevis are associated w/ ankle sprains;
          - look for tendon tear at the level of the distal fibula;
          - persistent swelling along the peroneal tendon sheath is a reliable sign for peroneus brevis tendon tear;
          - this injury tends to occur from peroneal tendon subluxation over the posterolateral edge of the fibula;
          - inciting cause is incompetence of the superior peroneal retinaculum;
                 - this allows subluxation of the peroneal tendons and mechanical attrition of the peroneus brevis tendon against the posterior ridge of the fibula;
          - treatment: needs to address the tear and the peroneal subluxation;
                 - w/ damage of less than 50% tendon substance, consider tendon debridment;
                 - w/ damage of more than 50% of the tendon cross sectional area, consider excision of the damaged segment and tenodesis to the peroneus longus;


- Peroneus Brevis Muscle Flap:
    - see: soft tissue coverage of the leg;
    - peroneus brevis muscle is the most useful flap to reconstruct small defects of the distal third of the lower leg;
    - located in lateral compartment & supplied by peroneal artery, transposition to small distal third wounds is feasible;
    - vertical incision over the fibula from the mid calf to the lateral malleolus is performed;
    - beneath the peroneus longus, the peroneus brevis is separated from EDL anteriorly and the soleus posteriorly;
    - dissection is continued proximally to the proximal third of muscle;
    - more proximal dissection risks injury to the vascular pedicle and should be avoided;
    - flap can then be transposed anteriorly

Peroneus brevis tendon tears: pathophysiology, surgical reconstruction, and clinical results

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Static or dynamic repair of chronic lateral ankle instability. A prospective randomized study.

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