Peroneus Longus

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The Peroneus Longus is a lateral muscle of the leg.

Anatomical Attachments:

• Origin: Attaches to the lateral head and the upper 2/3 of the lateral surface of the fibula.
• Insertion: Attaches into the base of the 1st metatarsal bone.

Action: Plantar flexes and turns the foot outward.

Synergist: Gastrocnemius, Flexor digitorum longus, Flexor hallucis longus, Peroneus brevis, Tibialis posterior, Soleus, Plantaris

Antagonist: Extensor hallucis longus, Extensor digitorum longus, Tibialis anterior, Peroneus tertius

Nerve Supply: Superficial Peroneal Nerve (L4, L5, S1)

Nerve Entrapment: Entraps the Peroneal nerve.

Vascular supply: Muscular branches of the anterior tibial and the peroneal arteries.

Peroneus Brevis

The Peroneus Brevis is a lateral muscle of the leg.

Anatomical Attachments:

• Origin: Attaches to the distal 2/3 of the lateral surface of the fibula.
• Insertion: Attaches into the tuberosity at the base of the 5th metatarsal bone.

Action: Plantar flexes, everts and abducts the foot.

Synergist: Gastrocnemius, Flexor digitorum longus, Flexor hallucis longus, Peroneus longus, Tibialis posterior, Soleus, Plantaris.

Antagonist: Extensor hallucis longus, Extensor digitorum longus, Tibialis anterior, Peroneus tertius.

Nerve Supply: Superficial Peroneal Nerve (L4, L5, S1).

Nerve Entrapment: Entraps the Peroneal nerve.

Vascular supply: Muscular branches of the peroneal arteries.

Peroneus Longus and Brevis as a Group

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Travell and Simons Trigger Point Pain Referral:  

• Primary: The pain refers over the lateral malleolus and occasionally spills over to the lateral aspect of the foot.
• Satellite or associated triggers: Extensor Digitorum longus, Tibialis posterior, gluteus minimus, Peroneus tertius/brevis.

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Trigger Point Signs and Symptoms: Weakness of the ankles, pain and soreness posterior and superior to the lateral malleolus, frequent sprains, foot drop if the deep peroneal nerve is entrapped, prone to ankle fractures.

Trigger Point Activating and Perpetuating Factors: According to Travell and Simons, prolonged immobilization such as having a foot in a cast, sleeping with the foot plantar flexed, or persistent sitting with legs crossed compromise the peroneal muscles. The peroneals also are compromised by an individual being flat footed, and/or wearing high heels. It is the peroneal muscles which seem to frequently be compromised in ankle sprains/strains with a twisting inverted motion of the foot.

Differential Diagnosis: Peroneal nerve entrapment, Morton foot structure, Lateral Compartment Syndrome, Ankle Sprain/Strain, Superficial vascular thrombosis, Tibia and/or Fibula fracture, Bone cancer, (Segmental, Subluxation, Somatic dysfunction) L4 or L5 radiculopathy, S1 neuropathy, Muscular Dystrophy, Charcot’s arthropathy, Reflex sympathetic dystrophy (Complex regional pain syndrome), Bursitis, Gout, Infectious arthritis, Rheumatoid arthritis, Osteoarthritis, Dislocation/Subluxation, Sciatic nerve lesion, Systemic infections or inflammation, Nutritional inadequacy, Metabolic imbalance, Toxicity, Side effects of medication.

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