One of the uncommon injuries that occurs to the ankle in sports involves the peroneal tendons. These are the tendons that are located behind the lateral malleolus, or the bone on the outside of the ankle. These tendons help turn the foot outward. Although rare, these injuries can occur in sports.
The common mechanism of injury involves inversion of the ankle, meaning that the heel of the foot turns inward while the outside of the ankle is forced down. This is also the same mechanism involved in most ankle sprains. When the athlete has traumatic inversion to his ankle, he might injure the tissue that holds the peroneal tendons behind the bone. If this happens, it allows the tendons to slip, or sublux, in front of the bone.
Causes of Peroneal Tendon Subluxation
Peroneal tendon subluxation is not common but can mimic the pain of a lateral ankle sprain. The tendons are forcibly pulled or snapped out of the bony grove they sit in behind the lateral anklebone. A forcible inversion injury to the ankle usually can be recalled by the patient when these tears are seen.
Symptoms of Peroneal Tendon Subluxation
- Pain when you turn the soles of the feet outwards and upwards (pronation).
- Pain or tenderness behind the lateral malleolus (bony bit on the outside of the ankle).
- Swelling and bruising.
Diagnose a Peroneal Tendon Subluxation
Clinical diagnosis of talar dome fractures can be highly challenging and are often missed. The patient may have sustained a fall or a twisting injury to the ankle and may generally ambulate with a limb. In the acute setting, the symptoms of a talar dome fracture are similar to and often occur with an ankle sprain. In lateral talar dome lesions, tenderness is generally found anterior to the lateral malleoli, along the anterior lateral border of the talus. In medial talar dome lesions, tenderness is usually located posterior to the medial malleolus, along the posterior medial border of the talar dome.
Chronic talar dome lesions, traumatic and atraumatic osteochondritis dissecans lesions may have a clinical presentation similar to that of arthritis. Typical findings include crepitance, stiffness, and recurrent swelling with activity.
Treatment for Peroneal Tendon Subluxation
As with all injuries, treatment begins with diagnosis. Diagnosis of this problem is often delayed as the athlete is assumed to have a common ankle sprain or tendinitis that won’t heal. Repeat examinations and sometimes an MRI are necessary to make the diagnosis.
Rest, sometimes to include immobilization for a short period in a cast, will often resolve the problem. Antiinflammatory medication and cross training are helpful. Bracing or taping when an athlete returns to play
is often needed.
Alternative Treatment Options
- Glucosamine or Lubricant Injection
- Non-steroidal Anti-inflammatory Medications (NSAIDs)
When conservative care does not eliminate the problems, surgical stabilization and/or repairing the tear of the tendons may be required. Treatment involves either repairing or substituting for the damaged strip of tissue. Alternatively the fibula bone at the ankle can be cut and repositioned or a groove can be cut into it to lessen the chances of the tendons moving.
The fibular grooving procedure appears to reproducibly alleviate resubluxation of the peroneal tendons anddiminish pain. It also allows for retainment of motion and subsequent return to work and sports with a high satisfaction rate.
Surgery has its usual risks and success rates of 80% in experienced hands.