Peroneal Tendon Surgery
This procedure is generally performed as a day case operation. You will be coming to the day case reception lounge on the day of operation. You will be checked into preoperative lounge and will be met by the surgeon and the anaesthetist who will go through all the benefits and risks of the surgery again. Surgery is performed under general anesthetic, usually as a day case. The procedure takes between 60-90 minutes. An ankle arthroscopy may be performed at the same time as the peroneal tendon surgery to allow the ankle to be inspected and cleaned.
An 8cm incision is made on the outer side of the ankle just behind the fibula, running along the length of the peroneal tendons. If the retinaculum holding the tendons in place is damaged this will be repaired. The tendons are inspected, and any tendon damage is repaired. The fibula is assessed to determine whether it needs to be re-shaped to hold the tendons in place. The skin is then stitched and a below knee backslab applied.
All surgery carries potential risks. The risks are minimised by having the surgery meticulously performed by an expert in foot and ankle surgery. Risks include
- Infection - approximately 1% risk in our unit
- Blood clots (thrombosis) – You will be given low molecular weight heparin to thin the blood to reduce the risk for 8 weeks.
- Numbness – between the toes after this surgery is common. Usually improves with time
- Pain and swelling - This can occur after any foot and ankle surgery. You have to keep the limb elevated for 48 hours to avoid swelling and you will be given pain killers.
- Stiffness – This is uncommon after this procedure. This improves over time and helped by physiotherapy
- Scar sensitivity - can be improved with scar massage with emollients.
- Incomplete improvement - occasionally symptoms will be improved but remain present to a small degree
Discharge advice following Peroneal Tendon Surgery
Your leg has been dressed with a plaster back- slab to give it support. This dressing should not be changed until you are seen at your first follow-up appointment after 2 weeks. The plaster must be kept clean and dry.
It is very important that you rest as much as possible and keep your foot elevated for the first 48 hours after surgery. Try to avoid letting it hang down when sitting as this will lead to swelling and pain. This is most apparent within the first 2 weeks but swelling may occur for up to 6 months after surgery, especially after sitting or standing for long periods. In bed, put the foot on a pillow.
You will receive a prescription for pain medication on discharge. Pain is often due to swelling, and this is eased by rest and elevation of the foot.
You will need to walk without putting any weight on the foot for 2 weeks. A physiotherapist will show you how to use crutches After this you will be supplied with a fiberglass plaster cast with toe touch weight bearing. This is worn for 4 weeks. You can take the boot off at night.
You will be seen approximately 2 weeks when the plaster and sutures will be removed. You will be placed in a fiberglass cast in which you can walk in. You will be seen again 4 weeks later and if all is well will be referred to the physiotherapists and you can discard the boot. You may need a small ankle support during the next 6 weeks, and this will be provided. This can be worn inside trainers and these should be brought to the 6 week appointment. You will be seen at 3 months for a final check.
Driving and work
You should not drive a manual car for 6 weeks following surgery. After this you should start gradually, to see if you are comfortable. It normally takes a few days to feel confident
If you have an office-based job, then it may be possible for you to return after 2 weeks however it is more advisable to return after 6 weeks. If you have a more physical job, then it may take 8-12 weeks.
It often takes 6 months for all swelling to resolve and so minor swelling late in the day is not unusual and should not be a cause for concern. It will take 6 months to return to full sporting activity.