The peroneal tendons are located on the outer side of your ankle. The tendons are firmly held in place in a groove behind your fibula. If the peroneal tendons slide out of the groove then you will have pain due to peroneal tendon subluxation. How do we diagnose and treat peroneal tendon subluxation. As Gareth Bale will be able to attest to, the recovery from peroneal tendon subluxation can last for months.
We have two peroneal tendons. The two tendons include the peroneus longus and the peroneus brevis. These two peroneal tendons play a critical role in balancing and controlling the motion of your foot. Injury to the peroneal tendons can occur as the result of a traumatic episode or due to chronic repetitive stress.
What Is Peroneal Tendon Subluxation?
As noticed in the diagram, the two peroneal tendons are held in place by a strong piece of tissue we call a retinaculum. If the retinaculum tears then the two peroneal tendons can subluxate or move in front of the fibula. The most common cause of peroneal tendon subluxation is an ankle sprain. During an inversion ankle sprain (the most common type) the tissues on the outside of your ankle are stretched. At the same time your tendons are pulling hard to resist that motion. That can put a lot of stress on the retinaculum holding the two tendons in place. Ultimately the retinaculum can tear or lift off the fibula and allow the peroneal tendons to subluxate or move towards the front of your ankle.
What are the symptoms of peroneal tendon subluxation?
The common symptom of peroneal tendon subluxation is a painful popping sensation on the outer side of your ankle. At the time of the injury or ankle sprain you may not notice the tendons are out of place. Especially because the entire outside of your ankle may now be swollen. As the swelling subsides, you will now notice that the tendons subluxate when you move your ankle upwards. The peroneal tendons do not stay subluxated. So they will go back into place when you move your foot downward. The tendons do not need to subluxate each and every time you move the ankle. Sometimes this will only occur with forceful motion and rotation, such as running around on a soccer field or basketball court.
How Do You Diagnose Peroneal Tendon Subluxation?
The diagnosis of peroneal tendon subluxation is generally very straightforward. Your Orthopedic Surgeon will ask you to move your ankle into certain positions. That will usually cause the peroneal tendons to subluxate which will be easy for us to feel. In situations where it isn’t clear we may need to obtain an MRI which will show us whether or not the retinaculum is torn or separated from the fibula.
How Do You Treat Peroneal Tendon Subluxation?
Gareth Bale will likely have surgery to repair his peroneal tendon dislocation. Do all cases of this require surgery? The short answer is no. If the injury is acute or fresh, then there is a chance that the retinaculum will heal if the foot is casted so the tendons stay in their normal position. If this treatment is unsuccessful then peroneal tendon subluxation is treated by fixing the retinaculum which holds the tendons in place. In many cases we are simply reattaching the retinaculum to the fibula. This is an open surgery. At the time of the surgery we also inspect the two tendons to be sure there is no evidence of a peroneal tendon tear. If a tear is noted then the tendon will be fixed at the same time that the retinaculum is repaired.
What is the Recovery From Peroneal Tendon Subluxation?
After the repair we need to give the retinaculum time to heal back to the bone. That healing process can take many months. Physical therapy will usually start within 4-6 after surgery to start to improve your motion. After months of strengthening, conditioning and sports specific training the retinaculum should have the strength and stability to allow you to return to play.
Sierra
I sprained my ankle about two months ago then I rolled it in pe and I heard it pop or snap ever since then it will do the pop or snap and I can feel it and sometimes u can hear it it will do it over and over again should I be concerned
Howard J. Luks, MD
If the popping is because of the peroneal tendons then it is something that might require treatment. I would see an Orthopedic Surgeon who can help you.
John mcpherson
I landed hard on my ankle over 2 years ago. My doctor did not see a clear injury at the time and sent me away. Sine then, I have not been able to walk or run for long periods and I can crack my ankle repeatedly after a day of work. It also appears swollen. My doctor has now performed an X-ray and MRI, but is not seeing anything. I am frustrated and my ankle is always sore. I need relief as this is affecting my agility to enjoy life.
What do I do next?
Howard J. Luks, MD
See a second opinion … and perhaps an Orthopedic Surgeon who specializes in Foot and Ankle surgery.
Rachel
Sounds like tendinitis
ch ch
I never sprained my ankle (that I know of) and my ankles and other joints have always cracked like to the extreme whenever I move and now I have an ache in my outer left ankle especially after it pops or snaps, should I see someone? would this still be peroneal tendon subluxtion or something else?
Howard J. Luks, MD
Hi … Not all cases of snapping or popping on the lateral side of the ankle is due to the peroneal tendons. You may want to see your doctor for an examination…it’s usually very easy to tell if the peroneal tendons are responsible for the snapping.
Kunle Ajayi
Hello Dr,
Thanks for your post. It was very enlightening. I have had popping and snapping as well as pain in my right ankle for over 2 years now. The pain becomes excruciating when I walk, however I noticed that I feel less pain with new footwear. After a week though, I return to experiencing the pain more intensely and walking becomes very difficult. I soon realized that the increase in pain was partly induced by the wearing off of the right side of the sole of my right shoe. Consequently, I fixed a steel plate on the sole…and this seemed to make walking more tolerable…at least until the steel plate wear off too. Fast forward. . …the orthopedic surgeon I saw recently said the MRI scan did not show anything wrong. …that my tendons were ok. Although this was good news…it hasn’t changed my situation. He suggested I should use the shoes that cause me intense pain…and let my ankle get imflammed and then have another MRI scan…that way he can really see what is going on. I was wondering if you wouldn’t mind sharing your thoughts on this problem.
Howard J. Luks, MD
Peroneal tendon subluxation is seen on the physical examination. The MRI might show a loose retinaculum… and in advanced cases it might shows small tears in the tendon. But this is a diagnosis which reveals itself on examination every time. Perhaps you can seek another opinion? Perhaps you can find an Orthopedic Surgeon who specializes in Ankles. They are out there.
Good luck
Shana
I have rolled and sprained my ankle numerous times. A few months ago something started popping out of place often, when I’d go downstairs. When it happens it feels like something inside is unstable, and the pain is pretty bad. It hurts behind my ankle, especially when I id try to walk, specifically when id push off with the ball of my foot. But if I kinda kicked my foot a few times it would resolve. However now it seems to be happening at random times and often stays out for several hours, and when it happens it is too painful to use the foot at all. My ankle is also now chronically swollen. There’s a bit of pain most of the time but generally only unbearable when the popping happens. My MD suspects the peroneal tendon is subluxing and I’m awaiting xray results….sincerely hoping it’s not as my primary job is a dog walker!
Howard J. Luks, MD
good luck… We wish you well.