Premium Nahrungsergänzungsmittel | artgerecht

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.

Regular tips about health Regular tips about health

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.