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Peroneus Longus Avulsion Fracture

Case Detail

Anatomy: Musculoskeletal
Joseph Junewick, MD FACR
Diagnostic Category: Trauma
Created: over 7 years ago
Updated: over 7 years ago
Tags: PEDS
Modality/Study Types: MR
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Teenage female with foot pain after gymnastics injury.

Case Images


Peroneus Longus Alvulsion Fracture


MR – Serial fat-suppressed T2 images show an oblique fracture of the plantar base of the first metatarsal with intact peroneus longus tendon and associated soft tissue edema.


The peroneus longus muscle arises from the posterior and lateral aspects of the fibula. The muscle has a long musculotendinous junction that ends above the level of the distal portion of the fibula. The tendon changes direction at the level of the lateral malleolus. Passing below the peroneal tubercle of the calcaneus, the peroneus longus tendon enters a fibro-osseous tunnel beneath the cuboid bone and transverses the sole of the foot to attach to the medial cuneiform bone and the base of the first metatarsal bone. About 25% of all patients have a sesamoid bone within the tendon in the region of the cuboid tunnel. Most peroneal injuries occur at the myotendinous junction laterally at the ankle and less commonly in the tendon along the plantar aspect of the foot. Avulsion fractures are unusual but forceful contraction of the peroneus muscle during certain athletic activities with a fixed foot may predispose. Internal fixation may be necessary.


Zermatten P, Crevoisier X. Avulsion fracture of the peroneus tendon insertion at the base of the first metatarsal: report of a case. Foot Ankle Surg (2011); 17:e10-e12.

Rademaker J, Rosenberg ZS, Delfault EM, et al. Tear of the Peroneus Longus Tendon: MR Imaging Features in Nine Patients. Radiology (2000); 214:700-704.

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