Correlation between foot longitudinal arch shape and peroneal compartment pathology.

Objective: This study assesses whether a correlation exists between the shape of the medial longitudinal arch of the foot measured on weight-bearing radiographs and risk for peroneus longus and brevis pathology.

Methods: After institutional approval, a retrospective search was conducted for patients who presented between 2017 and 2023 with foot and ankle pain, and for whom ankle MRIs and weight-bearing ankle radiographs were performed within 6 months of each other. One hundred forty-one cases of peroneal tendon dysfunction that met the criteria were identified. Talonavicular uncoverage angle, Meary's angle, calcaneal pitch, cuneiform-to-fifth metatarsal height, and Djian-Annonier's (DA) angle were calculated on weight-bearing ankle radiographs. MRI was used to assess the peroneus brevis tendon, peroneus longus tendon, common peroneal tendon sheath, and the peroneus brevis and longus tendon sheaths. Associations between radiographic angles and MRI findings were explored through one-way ANOVA followed by Tukey's HSD method for multiple comparisons.

Results: Significant differences between patients with normal tendons or tendinosis versus tears of the peroneus brevis tendon were found using Meary's angle. The study also demonstrated statistically significant differences between the calcaneal pitch angle in patients with peroneus longus tenosynovitis vs normal peroneus longus tendon sheath.

Conclusions: This study demonstrated that Meary's angle and calcaneal pitch can assist in stratifying risk for peroneus brevis tendon tears and peroneus longus tenosynovitis, respectively.