When we hear the term dislocation, we oftentimes think of it in context with a joint in the body, like a shoulder or a hip that pops out of its socket. However, those are not the only areas that can dislocate as a result of acute force. Your tendons, for example, can become dislocated based on the force patterns they are subjected to. One of the most common tendon dislocations that we see is the peroneal tendon dislocation.
Peroneal tendon dislocation, also known as peroneal tendon subluxation, occurs when an elongation, a tear or a separation of the the superior peroneal retinaculum occurs (the superior peroneal retinaculum is the fibrous band that stabilizes the peroneal tendons). This causes the peroneal tendons to slip out of fibular groove that helps to hold them in a secure location. This dislocation and trauma to the peroneal tendons can cause a host of symptoms, and careful attention should be paid to help an individual treat the injury. We take a closer look at peroneal tendon subluxation in today’s blog.
Causes And Symptoms
There are two peroneal tendons in each foot, and they run side-by-side on the outside of your foot to provide stability to the foot and support to your arch. Oftentimes they are injured or dislocate during a specific type of ankle sprain, usually involving a sudden, forceful upward flexing or outward turning of the ankle. It’s most common in athletes and individuals who do a lot of running, jumping or quick changes of direction on their feet.
Symptoms of a peroneal tendon subluxation include:
- Pain along the outside of your foot
- Tenderness
- Difficult walking
- A snapping or popping sensation on the outer side of your ankle
- Swelling
- Bruising
- Ankle instability
Diagnosis And Treating Peroneal Tendon Subluxation
Because of the nature of the injury and the symptoms you’ll deal with, peroneal tendon injuries are oftentimes misclassified as a lateral ankle sprain. Both injuries involve targeting damaged soft tissues, but their treatment courses are inherently different, so you’ll want to know exactly what you’re dealing with if you suspect that your peroneal tendons have been affected.
During an assessment, your doctor will ask you questions about your injury and take a closer look at the area in the form of a physical exam. They will likely have you manipulate your foot and ankle in a few different ways to see how it responds to stress. Standing up straight and rotating your ankle while your doctor applies pressure to your peroneal tendons can help them assess whether the tendons have been damaged or dislocated.
Treatment will depend on the extent of the damage or dislocation. In many instances, low-grade peroneal tendon injuries or dislocations will heal sufficiently without surgical intervention. However, they won’t get back to full health on their own. Targeted, active intervention works best. Ice and rest will be helpful in the beginning stages of recovery, but eventually you’ll need to work to strengthen the peroneal tendons with physical therapy, gentle stretching and a gradual return to more physical activities. If you don’t help these tendons get back to a pre-injury level of fitness, you may deal with long-term ankle weakness and instability, and you’ll also be at a heightened risk for another sprain.
For more severe subluxations, for chronic dislocations or in cases where the patient is not responding well to conservative treatment, surgery may be advised. The specific nature of the operation will depend on your unique circumstances. The surgeon may repair and reattach the superior peroneal retinaculum, address tears within the peroneal tendon, deepen the groove within which the tendons sit or add a bone graft to the ankle to make it harder for the tendons to shift out of the groove. Your doctor will walk you through your recovery protocol based on your specific operation, but most patients are non-weight bearing for two weeks after the procedure before eventually transitioning to partial weight bearing around the 2-6 week mark. Most patients can bear their full weight by 6-12 weeks, but return to more intense physical activity and athletics can take 3-12 months, or longer.
For more information about peroneal tendon injuries or ankle injuries in general, reach out to Dr. Silverman by filling out this contact form.