BACKGROUND:
Concomitant chronic tears of both peroneal tendons rarely are reported. We present our experience in treating these injuries and suggest an algorithm for surgical treatment, determined by the presence of a functioning tendon or tendons, mobility of the remaining peroneal musculature, ankle stability, and position of the heel.

METHODS:
Twenty-eight consecutive patients (29 feet) were followed postoperatively for a mean of 4.6 (range 1.5 to 8) years. The mean age was 36 (range 19 to 54) years, and all patients had chronic ankle pain with or without instability and with combinations of complete, partial, or longitudinal tears of both tendons. Of the 28 patients, six had hindfoot varus and three had cavovarus. Eight patients had mechanical ankle instability, but there was no correlation between instability and the presence of hindfoot varus.

RESULTS:
The mean postoperative American Orthopaedics Foot and Ankle Society ankle score was 82 (range 20 to 100) points, and 91% of patients achieved normal or moderate peroneal muscle strength. Ankle instability was successfully corrected in all patients and progressive worsening of varus deformity was prevented.

CONCLUSION:
The presence of chronic peroneal tendon subluxation or dislocation, chronic ankle instability, or hindfoot varus deformity, in association with retrofibular pain and swelling, should alert the surgeon to the possibility of a tear of the peroneal tendons and is an indication for surgical intervention. At the time of tendon repair, every effort should be made to treat the primary or contributing causes of the tear. Our results suggest that patients with symptomatic concomitant peroneus longus and brevis tendon tears are likely to experience substantial improvement in function if operative treatment is adequate.