Peroneal Tendon Subluxation and Dislocation

The peroneal tendons are strong bands of tissue that connect a bone in your foot to the muscles that let you turn your feet outward and stand on your toes (peroneal muscles). The tendons pass under the ankle and into a groove of bone. Peroneal tendon subluxation and dislocation are injuries that happen when the peroneal tendons move out of this groove. The injuries can make your ankle weak and can make your ankle and foot hurt.

What are the causes?

This condition may be caused by:

• A severe ankle sprain.
• Wear and tear from repeated ankle stress (overuse).

What increases the risk?

This condition is more likely to develop in people who play sports in which there is a risk of spraining an ankle or having the foot be forcefully pushed up and in. These sports include:

• Skiing.
• Hockey.
• Ice skating
• Football.
• Soccer.
• Basketball.
• Gymnastics.

What are the signs or symptoms?

Symptoms of this condition may start suddenly or develop gradually. Symptoms include:

• Pain in the back of the ankle.
• A snapping or popping feeling or sound.
• Swelling in the ankle.
• Bruising in the ankle.
• A weak and wobbly ankle or a feeling that your ankle is giving way (ankle instability).
• Tenderness in the ankle.

How is this diagnosed?

This condition may be diagnosed based on:

• Your symptoms.
• Your medical history.
• A physical exam.
• Tests, such as:
  • An X-ray or CT scan. These may be done to check your ankle bone.
  • MRI or ultrasound. These may be done to check your tendon.

How is this treated?

Treatment for a subluxation injury may include:

• Keeping your body weight off of your ankle for up to 6 weeks. This treatment involves using a device to help you walk, such as crutches or a walker.
• Wearing a boot or cast to support your ankle and keep it still.
• Applying ice to the ankle to reduce swelling.
• Taking anti-inflammatory pain medicine.
• Having medicines injected into your tendon to reduce swelling.
• Doing exercises (physical therapy).
• Returning gradually to full activity.
• Surgery. This may be needed if the injury comes back or does not get better after 3–6 months.

Treatment for a dislocation injury usually involves surgery:

• To repair any tears in the tissue that holds your tendons in place (retinaculum).
• To create a groove behind the ankle.
• To secure the tendons in place with sutures, screws, or pins.

Follow these instructions at home:

If you have a boot:

• Wear it as told by your health care provider. Remove it only as told by your health care provider.
• Loosen the boot if your toes tingle, become numb, or turn cold and blue.
• If the boot is not waterproof:
  • Do not let it get wet.
  • Cover it with a watertight covering when you take a bath or a shower.
• Keep the boot clean.

If you have a cast:

• Do not put pressure on any part of the cast or splint until it is fully hardened. This may take several hours.
• Do not stick anything inside the cast to scratch your skin. Doing that increases your risk of infection.
• Check the skin around the cast every day. Tell your health care provider about any concerns.
• You may put lotion on dry skin around the edges of the cast. Do not put lotion on the skin underneath the cast.
• If the cast is not waterproof:
  • Do not let it get wet.
  • Cover it with a watertight covering when you take a bath or a shower.
• Keep the cast clean.

Managing pain, stiffness, and swelling

• Take over-the-counter and prescription medicines only as told by your health care provider.
• If directed, apply ice to the injured area:
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Move your toes often to avoid stiffness and to lessen swelling.

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do not use your leg to support (bear) all of your body weight until your health care provider says that you can. Use crutches or a walker as told by your health care provider.
• Do not do any activities that make pain or swelling worse.
• Do exercises as told by your health care provider.

Driving

• Do not drive or operate heavy machinery while taking prescription pain medicine.
• Ask your health care provider when it is safe to drive if you have a cast or boot on your leg.

General instructions

• Do not use any tobacco products, such as cigarettes, chewing tobacco, and e-cigarettes. Tobacco can delay bone healing. If you need help quitting, ask your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

How is this prevented?

• Wear supportive footwear that is appropriate for your athletic activity.
• Avoid athletic activities that cause pain or swelling in your ankle or foot.
• See your health care provider if you have pain or swelling that does not improve after a few days of rest.
• Stop training if you develop pain or swelling.
• If you start a new athletic activity, start gradually so you can build up your strength and flexibility.

Contact a health care provider if:

• Your symptoms get worse.
• Your symptoms do not improve in 2-4 weeks.
• You develop new, unexplained symptoms.
• Your splint, boot, or cast becomes loose or damaged.

Peroneal Tendon Subluxation and Dislocation Rehab

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse. Do not begin these exercises until told by your health care provider.

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your ankle. These exercises also help to relieve pain and stiffness.

Exercise A: Ankle plantar flexion

1. Sit with your left / right leg crossed over your opposite knee.
2. Use your opposite hand to pull the top of your foot and toes toward you. You should feel a gentle stretch on the top of your foot and ankle.
3. Hold this position for __________ seconds.

Repeat __________ times. Complete __________ times a day.

Exercise B: Gastroc, standing

1. Stand with your hands against a wall.
2. Extend your left / right leg behind you, and bend your front knee slightly. Your heels should be on the floor.
3. Keeping your heels on the floor and your back knee straight, shift your weight toward the wall. You should feel a gentle stretch in the back of your lower leg (calf).
4. Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times a day.

Exercise C: Soleus, standing

1. Stand with your hands against a wall.
2. Extend your left / right leg behind you, and bend your front knee slightly. Your heels should be on the floor.
3. Keeping your heels on the floor, bend your back knee and shift your weight slightly over your back leg. You should feel a gentle stretch deep in your calf.
4. Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times a day.

Strengthening exercises

These exercises help to build strength and endurance in your toes, foot, and ankle. Endurance is the ability to use your muscles for a long time, even after they get tired.

Exercise D: Towel curls

1. Sit in a chair on a non-carpeted surface, and put your feet on the floor.
2. Place a towel in front of your feet. If told by your health care provider, add __________ to the end of the towel.
3. Keeping your heel on the floor, put your left / right toes on the towel.
4. Pull the towel toward you by grabbing the towel with your toes and curling them under. Keep your heel on the floor.
5. Let your toes relax.
6. Grab the towel again. Keep going until the towel is completely underneath your foot.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise E: Isometric eversion

1. Sit in a chair with the outer edge of your left / right foot against a sturdy object, such as a wall or a table leg.
2. Slowly push your foot out against the wall or table leg. Your foot should not move.
3. Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times a day.