Disclosures: Allison N. Schroeder, MD: Nothing to disclose

Case Description: A 54-year-old recreationally active female presented to our clinic with left lateral foot pain. On evaluation, her pain was a 4/10 deep ache over the left lateral foot that was exacerbated by excessive walking or activity. She was previously diagnosed with non-traumatic peroneus brevis tendinopathy by her podiatrist and had received 4 corticosteroid injections with intermittent benefit over the last few years. She also completed 6 weeks of supervised physical therapy with limited improvement. She denied numbness, tingling and weakness. Examination was remarkable for focal tenderness to palpation over the peroneus brevis insertion on the left, and pain with resisted ankle eversion.

Setting: Outpatient musculoskeletal/sports medicine clinic

Patient: 54-year-old recreationally active (cycling, hiking, yoga) female.

Assessment/Results: MRI obtained 8 months prior to presentation to our clinic showed minimal peroneus longus and brevis tenosynovitis and no high-grade tear or high-grade tendinopathy. Ultrasound evaluation was completed in our clinic and revealed calcific insertional peroneus brevis tendinosis. Over the next 8 months, she received sonographically-guided injections of prolotherapy (1) and PRP (3) with only intermittent relief, as pain would return with increased activity. She then underwent left sonographically-guided percutaneous ultrasonic tenotomy and debridement. Following the procedure, she was instructed to use a walking boot with crutches for 3-7 days followed by gentle range of motion exercises with progression to strengthening exercises in physical therapy at 2-3 weeks. Three months after the procedure, she was able to go on a European hiking excursion with improved pain. She was pain-free 1 year after the procedure.

Discussion: Percutaneous ultrasonic tenotomy has been shown to be effective in treatment of calcific tendinopathy. To our knowledge, this is the first report on use of percutaneous ultrasonic tenotomy to treat insertional calcific peroneus brevis tendinosis.

Conclusion: Percutaneous ultrasonic tenotomy should be considered to treat insertional calcific peroneus brevis tendinosis when other treatment options are unsuccessful.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/calcific-insertional-peroneus-brevis-tendinosis-treated-with-percutaneous-ultrasonic-tenotomy-a-case-report/