What is Peroneal Tendon Dislocation? Causes, Treatment, & More

Peroneal tendon dislocation is a common problem for Chicago, Illinois, athletes and people who do a lot of walking or hiking. Two peroneal tendons are side-by-side behind your outer ankle bone, and they connect the peroneal muscles in the outer calf to the metatarsal bones in the foot. They’re called the peroneus brevis and the peroneus longus.

The peroneus brevis tendon attaches to the outer part of the foot, and the peroneus longus goes underneath the foot and attaches near the arch. Peroneal tendons help stabilize the foot, protecting it from sprains by letting people adjust the angles of their feet and keep their balance more easily. Here’s some more information about peroneal tendon dislocation, what causes it, and the treatments available.

What Is Peroneal Tendon Dislocation?

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The peroneal tendons usually sit in a groove behind the bony lump at the base of the calf bone or fibula. With a peroneal tendon dislocation, one or both peroneal tendons move out of position, which makes moving the foot difficult — movement in some of the bones and joints is often out of place.

A subluxation is a less severe dislocation where the joint surfaces still touch, but they’re not in the correct positions in relation to one another. Most peroneal tendon dislocations are subluxations. They often seem minor, but they can become more severe without the correct treatment from a podiatrist

Common symptoms of peroneal tendon dislocation include sharp pain behind the outer ankle bone when you move your foot inwards or stand on it and rotate it inward. You could also notice a snapping, popping, or clicking sound and feel the tendons moving more than usual when you use your ankle. Many people call peroneal tendon dislocation “snapping ankle” because of this strange symptom.

You could also experience tenderness behind the bone on the outer side of your ankle or weakness or instability, also called anterolateral ankle instability. You might also have trouble walking normally, a reduced range of movement, swelling, redness, or bruising. You might even be able to see one or both peroneal tendons. They may move across the bone on the outside of your ankle when you move in bare feet, especially when you point your toe. The tendons could also stay stationary most of the time, at least to the naked eye.

What Causes a Dislocated Peroneal Tendon?

The most common cause of a dislocated peroneal tendon is a twisted or sprained ankle. Moving your foot upward and inward in a sudden way can force one or both tendons out of their groove.

Peroneal tendon dislocations often occur with an injury of the superior peroneal retinaculum, the band of tough, fibrous tissue that normally supports the peroneal tendons and holds them in place. You could also have an injury to the inferior peroneal retinaculum, a similar band of tissue below the side of the ankle, near the bottom of the foot and the end of the peroneus brevis tendon. Your doctor may request an MRI to determine the full extent of your injuries.

Who Does Peroneal Tendon Dislocation Affect?

Many athletes experience peroneal tendon dislocation, especially dancers and skiers. Both sports can involve frequent falls and ankle injuries. They also involve repetitive movements that can lead to peroneal tendon dislocation over time. Many people don’t notice an initial injury, and pain and other symptoms appear slowly, as the issue gets worse.

Without treatment, a dislocated tendon could eventually tear. This is called tendonosis, and it can lead to a dislocation as well. With tendonosis, the tendon stretches with wear over time, and it eventually frays. Like dancers and other athletes, people with high arches are more likely to have tendonosis. Congenital peroneal dislocations are possible as well. Some people have shallow grooves for the peroneal tendons on the sides of their ankles, making dislocation likely.

People with neuromuscular disorders are more likely to get a peroneal tendon dislocation because they’re at greater risk of falling. They could also have an abnormal gait and reduced sensation in their ankles and feet. Remember that anyone can get a dislocated peroneal tendon by twisting their ankle, tripping, or just repeating the same motions too often. If you think you could have a dislocated peroneal tendon, have it examined by a podiatrist as soon as possible.

What Treatments Are Available?

Doctors can wrap a patient’s ankle in tape or a compressive bandage to allow the tendons and the tissue around them to heal. They can also recommend using a brace either full-time or during activities that require repetitive ankle motion. Oral or injected analgesics and anti-inflammatory drugs can help reduce pain, redness, and swelling after an injury. 

Applying ice, heat, or ultrasound therapy can also reduce pain and swelling. Doctors can recommend a plaster cast or a walking cast as well. As the dislocated peroneal tendon heals, exercises can help improve patients’ balance and range of motion. Some patients see a professional physical therapist for a faster recovery.

Should I Have Peroneal Tendon Surgery?

In more than half of cases, patients eventually need surgery for peroneal tendon dislocation. Without it, the problem is likely to keep recurring, especially for athletes or other people who participate in lots of physical activities. Doctors usually try more conservative treatment for four to six weeks. Then, they recommend surgery if the patient doesn’t experience any improvement. Peroneal tendon surgery usually requires general anesthesia, but it’s an outpatient procedure. The surgeon will repair any tears in tendons or retinacula with sutures, and they may deepen the groove where the peroneal tensons rest. You’ll have to use crutches and take some time away from work for proper healing. You’ll also need to avoid driving for at least two weeks.

To learn more about peroneal tendon dislocation, contact us. Dr. Schoene is a podiatrist and certified athletic trainer with plenty of experience treating peroneal tendon dislocations. She’s an experienced surgeon, and she’s a faculty member at the Dr. William M. Scholl College of Podiatric Medicine. It’s part of the Rosalind Franklin University of Medicine and Science.