Peroneal Tendon Subluxation: The Other Ankle Sprain
Peroneal tendon subluxation is an uncommon cause of lateral ankle pain that is often misdiagnosed as a simple ankle sprain.
It is commonly associated with sports that require cutting such as skiing, basketball, soccer, and football.
The subluxation occurs when there is a forceful contraction of the peroneal tendon while the foot is dorsiflexed and inverted.
Patients will often complain of pain at the posterolateral ankle that started as a forceful pop. They may also complain of snapping or popping around the lateral malleolus as it continues to sublux.
On clinical exam, the patient will often have pain along the retrofibular groove. The peroneal tendon can be tested by actively dorsiflexing and everting the ankle from a plantar-flexed and inverted position. You should be able to see or feel the subluxation. Passive circumduction of the ankle may also recreate the subluxation.
Conservative management (i.e.: ankle brace, cast or walking boot) is associated with a low success rate; therefore, these patients should be referred to sports medicine or orthopaedics for possible operative repair.
References
Roth et al. Peroneal tendon subluxation: the other lateral ankle injury. Br J Sports Med (2010) vol. 44 (14) pp. 1047-53
