If you have peroneal tendon subluxation of your ankle, can you get better with rehab, physical therapy, taping or a brace? When do you need surgery? I address those concerns in my latest Ask Dr. Geier column.

Bob asks:

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%.

What is peroneal tendon subluxation?

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.

Do you need surgery for peroneal tendon subluxation?
The peroneal tendons are located behind the lateral malleolus on the outside of the ankle (white arrow).

Mechanism of injury

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.

Also read:
Peroneal tendon subluxation
Ankle injury: 7 common injuries suffered by athletes and active people
Common ankle injuries in sports and exercise

Surgery for peroneal tendon subluxation

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.

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