Reports have demonstrated that peroneal tendon tears can be successfully treated by direct repair or debridement and tubularization, based on the extent and nature of the pathology. Irreparable peroneal tendon tears or completely unsalvageable tendons after failure of previously attempted repairs are rare, and as a result there is a lack of high-level evidence to guide the management of these complex injuries. When irreparable tears are encountered the salvage options include tenodesis, bridging of the defect using allografts or autografts, and tendon transfers. The choice of treatment strategy depends on the presence of a functioning tendon or tendons and the viability and excursion of the peroneal musculature.