Peroneal Tendon Dislocation: Causes, Symptoms & Treatment
Peroneal tendon dislocation occurs when the peroneal tendons slip out of their normal groove behind the lateral malleolus, often due to a sudden ankle injury during sports.
Things worth knowing about "Peroneal tendon dislocation"
Peroneal tendon dislocation occurs when the peroneal tendons slip out of their normal groove behind the lateral malleolus, often due to a sudden ankle injury during sports.
What is Peroneal Tendon Dislocation?
Peroneal tendon dislocation refers to the displacement of the peroneal tendons – the tendons of the peroneus longus and peroneus brevis muscles – out of their natural groove behind the lateral malleolus (the outer ankle bone). Under normal circumstances, these tendons are held securely in a fibro-osseous tunnel by the superior peroneal retinaculum, a fibrous band that acts as a restraint. When this retinaculum is torn or stretched beyond its limits, one or both tendons can dislocate from the groove.
Causes
The most common cause is a sudden, forceful dorsiflexion (upward bending) of the foot combined with eversion (outward rotation), which places extreme stress on the superior peroneal retinaculum. Common scenarios include:
- Sports injuries such as skiing, soccer, basketball, and running
- Falling on uneven ground
- Sudden change of direction during athletic activity
- Chronic overuse with repeated subluxation (partial dislocation) in some cases
Anatomical predisposing factors include a shallow or convex retro-malleolar groove, which provides less mechanical containment for the tendons.
Symptoms
The symptoms of peroneal tendon dislocation closely resemble those of a lateral ankle sprain, which is why this condition is frequently missed or misdiagnosed. Typical symptoms include:
- Sudden, sharp pain behind and below the lateral malleolus
- Swelling and bruising around the outer ankle
- A snapping or popping sensation at the time of injury
- A feeling of instability at the ankle
- Pain during foot movement, particularly resisted eversion or push-off
- In chronic cases: recurring snapping or tendon displacement during ankle movements
Diagnosis
Diagnosis is established through clinical examination and imaging studies:
- Clinical examination: The physician performs provocation tests such as resisted eversion and direct compression of the peroneal tendons to assess stability and reproduce symptoms.
- Ultrasound: Allows dynamic, real-time visualization of tendon position and retinaculum integrity; useful for detecting subluxation during movement.
- MRI (Magnetic Resonance Imaging): The gold standard for evaluating retinaculum tears, tendon lesions, and associated injuries in detail.
- X-ray: Used to rule out bony avulsion fractures at the tip of the lateral malleolus.
Classification
Peroneal tendon dislocations are commonly classified according to the Eckert and Davis system:
- Grade I: The retinaculum is stripped from the fibula but not torn.
- Grade II: The fibrocartilaginous labrum is detached from the malleolus together with the retinaculum.
- Grade III: A bony fragment (avulsion fracture) is pulled off with the retinaculum.
Treatment
Conservative Treatment
In selected cases of first-time, low-grade acute dislocation, conservative management may be attempted:
- Immobilization in a below-knee cast or walking boot for 4–6 weeks
- Ice application and elevation of the foot during the acute phase
- Subsequent physiotherapy focused on strengthening the peroneal muscles and restoring ankle stability
However, conservative management is associated with a relatively high rate of recurrence, particularly in physically active individuals.
Surgical Treatment
Surgery is generally recommended for athletes, higher-grade injuries, or cases where conservative treatment has failed:
- Retinaculum repair: The torn retinaculum is reattached to the bone (reinsertion or direct repair).
- Groove deepening: If the retro-malleolar groove is too shallow, it can be surgically deepened to prevent future dislocation.
- Tendon repair: Any associated longitudinal tendon tears are sutured or reconstructed at the same time.
Postoperative rehabilitation involves a period of immobilization followed by progressive physiotherapy and gradual return to full weight-bearing and sport over several months.
Prognosis
With appropriate and timely treatment, the prognosis for peroneal tendon dislocation is generally favorable. Athletes can often return to sport within 3–6 months. Without treatment, the condition carries a significant risk of chronic instability, recurrent dislocations, and long-term tendon damage.
References
- Cerrato, R.A. & Myerson, M.S. (2009): Peroneal Tendon Tears, Surgical Management and its Complications. In: Foot and Ankle Clinics, 14(2), 299–312.
- Eckert, W.R. & Davis, E.A. (1976): Acute rupture of the peroneal retinaculum. In: Journal of Bone and Joint Surgery (American), 58(5), 670–672.
- Karlsson, J. et al. (2019): Peroneal Tendon Disorders. In: EFORT Open Reviews, 4(11), 677–685. DOI: 10.1302/2058-5241.4.180093.
Building Blocks for a Healthy Life
As an integrated manufacturer, we develop & produce evidence-based, patented, and non-patented formulations. We work exclusively with plant and natural extracts according to the strictest purity & quality standards.
The combination of science & modern technology with the laws of nature creates solutions consistently tailored to humans – for the highest good: health.
Most purchased products
For your iron balance
Specially formulated for your iron balance with plant-based curry leaf iron, Lactoferrin CLN®, and natural Vitamin C from rose hips.
For your universal protection
As one of the most valuable proteins in the body, lactoferrin is a natural component of the immune system.
For Healthy Oral Flora & Dental Care
Formulated lozenges with Dentalac®, lactic acid bacteria, and Lactoferrin CLN®Most read entries
3 Posts in this encyclopedia categoryMagnesiumcarbonat
Calorie content
Cologne list
Related search terms: Peroneal tendon dislocation