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Correlation between foot longitudinal arch shape and peroneal compartment pathology.

Adil Basha1, Rubeel Akram1, Natalie Velez1

  • 1Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, 75022, USA.

Skeletal Radiology
|June 16, 2025
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Summary

Foot arch shape, measured by Meary's angle and calcaneal pitch, can help predict the risk of peroneus brevis tears and peroneus longus tenosynovitis.

Keywords:
Magnetic resonance imagingPeroneus brevis tendonPeroneus longus tendonPes cavusPes planusRadiograph

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Area of Science:

  • Orthopedics
  • Radiology
  • Sports Medicine

Background:

  • Peroneus longus and brevis tendon pathologies are common causes of lateral ankle pain.
  • The medial longitudinal arch (MLA) shape is often assessed using weight-bearing radiographs.
  • Understanding the relationship between MLA morphology and peroneal tendon dysfunction is crucial for diagnosis and treatment.

Purpose of the Study:

  • To investigate the correlation between foot medial longitudinal arch (MLA) shape, assessed via weight-bearing radiographs, and the risk of peroneus longus and brevis pathology.
  • To determine if specific radiographic measurements can predict peroneal tendon tears or tenosynovitis.

Main Methods:

  • Retrospective review of 141 patients with foot and ankle pain, undergoing both weight-bearing ankle radiographs and ankle MRIs within a 6-month interval.
  • Calculation of radiographic angles including talonavicular uncoverage, Meary's angle, calcaneal pitch, cuneiform-to-fifth metatarsal height, and Djian-Annonier's (DA) angle.
  • MRI assessment of peroneus brevis and longus tendons and their sheaths, with statistical analysis (ANOVA, Tukey's HSD) to explore associations between radiographic measurements and MRI findings.

Main Results:

  • Meary's angle showed significant differences between patients with normal peroneus brevis tendons or tendinosis versus those with peroneus brevis tendon tears.
  • Calcaneal pitch angle demonstrated statistically significant differences between patients with peroneus longus tenosynovitis and those with normal peroneus longus tendon sheaths.

Conclusions:

  • Meary's angle is a useful radiographic measurement for stratifying the risk of peroneus brevis tendon tears.
  • Calcaneal pitch measurement can assist in identifying patients at risk for peroneus longus tenosynovitis.
  • Weight-bearing radiographic measurements of the medial longitudinal arch may serve as a valuable tool in predicting peroneal tendon pathology.