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What Does My MRI Scan Report Indicate?

Posted on Mon, 13 Apr 2015

Question: The MRI says "acute complete distal tear of the peroneus longus tendon, with 2 cm of retraction. Incidental small thin plantar fibroma involving the distal central cord, 11 mm ML x 12 AP x3 mm CC." His treatment is for me to wear one of those very large boots. I have been wearing the boot for about two weeks and my doctor, an ortho guy specializing in the foot, acknowledges that the tendon will not repair itself, but thinks overtime scar tissue will make it feel better. Says surgery is very delicate and difficult. I get the sense he does not feel comfortable performing surgery. What will scar tissue do to make it better and what information can you give me that will help me better understand length of treatment, my options and what might I expect? Thanks. XXXXXXX

Answered by Dr. Dr. Sudhir Kumar (39 minutes later)

Brief Answer:
Surgery is indicated.

Detailed Answer:

Hi
Thanks for your query

I'm Dr Sudhir Kumar

I have gone through your query and understand your concern. Your doctor is right is saying surgery is delicate and difficult as it will require tendon graft to fill the gap. It will not repaire itself.But you will feel better not due scar tissue but other tendon i.e. peroneus bravis will take over its function. However its repair is indicated. You will require nearly 6 weeks of immobilisations after surgery. There are only two options one is leave it as such. only rest for 2 weeks and gradually other tendon will take function. Second option is surgical repair.

You can discuss with your doctor about it.

Hope your query get answered. If you have any clarification then I will be happy to help you.

Wishing you a good health.
Take care.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Dr. Sudhir Kumar (11 hours later)

Thanks Doctor for your response. I have several follow up questions. (1) You seem to prefer surgery over leaving it as such. What are the advantages of surgery? (2) What is tendon graf and how is it done? (3) You mention immobilization of about 6 weeks after surgery. Is it done in a cast or a large boot like I'm currently wearing? And if in a cast will I be using crutches, etc.? (4) I'm currently away from home traveling across XXXXXXX in my RV. I'm not scheduled to return home until approximately May 1. Is surgery likely to be more effective if done sooner rather than later? I can return home sooner if necessary. (5) You refer to the peroneus bravis taking over. Can you explain? (6) Finally, can you explain in some detail what will be done during surgery? Thanks so much. XXXXXXX

Answered by Dr. Dr. Sudhir Kumar (32 minutes later)

Brief Answer:
Your answer is given below points wise.

Detailed Answer:
Hi
Welcome back
Following are point wise answer to your queries.
1. After repair eversion of foot will be better which is function of peroneus longus and bravis.
2.Other tendon of less importance is taken from body ( suppose one of extensor tendons of foot in this case)and grafted ( replaced) in the gap of peroneus longus gap.
3.Cast immobilisation will be used. You may or may not use cruches.
4. Surgery will be easier if done early.
5.Both peroneus muscles are evertors of foot. If one ( longus) is lost, its function will be gradually taken by other( brevis).
6.During surgery the ruptured tendon is exposed. Its ends freshened. Gap is judged. Other tendon of less important are taken from body and this is replaced and sutured in this gap.
You can discuss with your doctor about it.
Everything else already discussed.
If you have any further query, I would be glad to help you.
If not, you may close the discussion and if possible you may rate the answer for me, so that I get a good feedback.

In future if you wish to contact me directly, you can use the below mentioned link:
https://www.bit.ly/askdrsudhirortho

Wishing you good health
Take care

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Dr. Sudhir Kumar (34 hours later)

Thanks Doctor for your helpful info. I learned more about my condition from your two emails than I did from two office visits with my local orthopedist. And what you said helped me reference other additional info on the web. I now know what happened. About 4+ weeks ago, I stepped on an object and turned my ankle which took me to the floor. What I did not know at the time was that I injured my peroneus longus which weakened it to the point that when I pivoted on my foot 3+ weeks ago to hit an overhead volley in pickleball, it snapped completely. (1) To revisit the subject of when to operate, you mentioned that the earlier surgery occurs the simpler it will be. Have I already passed the optimum time for surgery and if not how long before it becomes more complicated? What complications arise by waiting? (2) I don't know if you make referrals, but if you do, do you have someone skilled in this particular surgical procedure in XXXXXXX and north of XXXXXXX FL in a place called The Villages? My son lives in XXXXXXX and I live in FL. Thanks. XXXXXXX

Answered by Dr. Dr. Sudhir Kumar (4 hours later)

Brief Answer:
Delay makes surgery difficult.

Detailed Answer:
Hi
Welcome back

1. If surgery is done early say within a week results are very good. Surgery is easy for surgeon and physiotherapy is easy. After 6 weeks surgery is generally avoided. In your case, 3 weeks has already passed. So if you have disability then surgery can be done. By doing surgery later, operation and physiotherapy become difficult.

2. I don't know about doctors of your area but you can consult any orthopedician or foot surgeon.

Everything else already discussed.
If you have any further query, I would be glad to help you.
If not, you may close the discussion and if possible you may rate the answer for me, so that I get a good feedback.

Wishing you good health
Take care

Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.

Above answer was peer-reviewed by : Dr. Shanthi.E