Ask Dr. Geier – Peroneal Tendon Subluxation
I am writing this column during some spare time before a Charleston Battery game. They are the professional soccer team here, and MUSC Sports Medicine serves as their sports medicine providers. I have had to treat several injuries among players this season that might not have been a problem if the player was not a high-level athlete. This week’s Ask Dr. Geier column deals with a problem that falls in that category.
As always, please keep in mind my disclaimer about giving specific medical advice online or by email.
David
Bob in Sewell, NJ asks:
Hello, I am not sure if you can or are allowed to answer this without seeing me, and I understand if you cannot, but I figured I would ask anyway.
I am a very competitive beach volleyball player and am very athletic in general. About six months ago I had hurt my calf and attempted to play my last three volleyball tournaments on the hurting calf. After about three weeks the pain did subside, but I noticed a painless ankle click. It mostly only clicks when I try to click it. I did not play any volleyball in my offseason, but my beach season is starting now, and after my first day back I had some discomfort in my lower calf region. I went to my doctor, and I was diagnosed with minor peroneal tendon subluxation. No MRI was taken, but I am in physical therapy now. I have researched this a lot in the past week and can’t seem to find any cases where PT has fixed this problem. While I know you cant tell me if it is possible that it will help me, have you heard of any cases where the PT did fix this? I was also wondering if athletes that do receive this surgery ever return to 100%.
Subluxation of the peroneal tendons can be a minor nuisance for average patients, but it can be very limiting in a competitive athlete. The peroneal tendons are the tendons that run behind the lateral malleolus (the bone on the outside of the ankle). These tendons are involved in rotation and turning the foot and ankle and are involved in stabilizing the foot and ankle on uneven surfaces, among other functions.
Injury to these tendons typically occurs with some sort of traumatic injury, such as a lateral ankle sprain. The sheath that holds these tendons behind the lateral malleolus ruptures, allowing the tendons to snap back and forth over the lateral malleolus with activities. While this snapping sensation may not be a big deal for someone who is not terribly active, for a high level athlete, this snapping can make exercise and sports very uncomfortable.
Treatment for this injury is typically surgical. If the problem is treated acutely, often the sheath that holds the tendons behind the lateral malleolus can be repaired primarily. If it is a chronic problem, a more formal reconstruction to recreate the sheath or deepen the groove behind the lateral malleolus might be needed. Surgical treatment usually allows the athlete to get back to sports at the same level in most cases. While physical therapy and other nonsurgical measures can be tried to treat the problem initially, these measures are often unsuccessful. I don’t think that taping, bracing, or physical therapy are bad options. However, if the tendons still sublux over the lateral malleolus, and the athlete is not able to compete at his or her normal level, I think an outpatient surgery and subsequent rehabilitation of the ankle after surgery are indicated.
C. David Geier Jr., M.D.
4 Comments
Thank you for this very informational post. I agree that I think surgery is the only answer for someone who has torn the muscle holding the tendons in place. I am recovering from my second ankle surgery (in 3 years) due to my peroneal tendons subluxing. I switched doctors this time because I think the first doctor didn’t do a great job, since a few years later it tore again from just a minor sprain. Hoping for a full and lasting recovery this time.
Hope it goes well! Glad you like the post!
Thanks for the article. I am a triathlete and I just had subluxation surgery by my podiatrist 4 weeks ago. I am really concerned about two things. One, the doctor did not know I had dislocated my peroneal tendon until he opened my foot. And secondly, he will not give me straight answer regarding the likely hood I will run again.
Should I be concerned? Should I have had the surgery done by an orthopedist instead of a podiatrist?
Thanks,
-Craig
Athletes that whose peroneal tendons remain stable in the groove behind the fibula after surgery to treat peroneal tendon subluxation typically return to sports. As for whether that surgery is better performed by an orthopaedic surgeon or podiatrist, I will abstain from blanket statements but emphasize that any surgery needs to be performed by someone comfortable and skilled with it.