Indication for peroneal longus to peroneus brevis tenodesis is overload of which metatarsal region?

• A. Second metatarsal overload
• B. Third metatarsal overload
• C. First metatarsal overload
• D. Fifth metatarsal overload

Answer: (C)

Forefoot biomechanics and first-ray stability are being tested here. The peroneus longus normally plantarflexes and stabilizes the first metatarsal, helping to support the transverse arch. When the first metatarsal region is overloaded—often from a hypermobile or unstable first ray—the load is excessive at the medial forefoot and can cause pain and deformity.

Transferring the longus to the peroneus brevis changes the force dynamics: the tendon no longer actively plantarflexes the first metatarsal as strongly, which reduces the excessive load on the first metatarsal head and redistributes forces across the forefoot. This unloading helps address symptoms and instability in the medial forefoot.

So, this procedure is indicated specifically for overload at the first metatarsal region, i.e., first-ray overload.