Nearly everyone has experienced an ankle sprain. If you are active in sports or participate in a lot of exercise you are very likely to have an ankle sprain at some point. The severity of the sprain can affect how quickly you will be able to recover. One of the worst case scenarios occurs when you sprain your ankle so badly that you have peroneal tendon subluxation. Most people haven’t ever heard of this condition, but many people experience it and have trouble finding out more information about it. It is fairly rare, so if you are lucky you may not ever experience it. However, some people are very unlucky, and will experience it one or more times. I am still recovering from my second occurrence. Being educated about your peroneal tendons may not be able to prevent  it from happening to you, but at least you will know what to do if it does happen.

Most people have never even heard of a peroneal tendon. The above image will give you a better idea of where these little tendons are in your ankle. They run on the outside of your ankle and are held in place behind the outer ankle bone. There are two tendons on each foot, and they are held behind the bone with a muscle called the peroneal retinacula. The tendons are there to stabilize your ankle, and (ironically) to prevent sprains.

Peroneal Tendon Problems

Subluxation is a fancy word, which basically means you have a partial dislocation.  In the case of your peroneals, this occurs when the tendons are no longer held in place, and are able to pop up and over the bone. This usually happens in a split second, and they will usually pop right back into place behind the bone after they come out. This stretches the tendons when they go over the bone, and over time they can tear or be weakened.

The subluxation is usually caused by a tear in the peroneal retinacula, as a result of a bad sprain, but some people may have this happen as a result of their genetics. Some people are born with a very shallow the groove behind the bone, which is where the tendons lie. A shallow groove can force the peroneals right out and over the bone when they are under stress. It is possible to have this condition even if you didn’t injure your ankle, if you were born with a shallow groove in your bone.

The subluxation may or may not be painful. It is characterized by a “pop” every time the tendons come out of their spot. This pop may even be loud enough to be heard. You can also see it happen, and it is fairly gruesome. After the initial sprain, your ankle will be swollen and show all of the normal characteristics of an ankle sprain. You may notice bruising around the ankle bone, and it will be very tender to the touch. Many patients and doctors mis-diagnose, thinking that the ankle bone is broken or fractured, because the symptoms are similar. For that reason, the first step in identifying the problem will often be x-rays.

One of the reasons that this rare condition is so undesirable is that many regular doctors will not be able to diagnose this. Both times that I have had a subluxing peroneal tendon, I went to instacare after I realized that it was more than a regular ankle sprain. Both instacare doctors couldn’t tell me what was wrong. The second time that it happened to me, the doctor refused to believe that I felt I had messed up my prior surgery, and told me that I was being paranoid and I only had a very minor ankle sprain. A couple hundred dollars and some x-rays later, he sent me home saying that nothing was wrong with me and that I shouldn’t even worry about taking it easy. If you think you may have hurt your ankle badly enough that you may have torn the peroneal retinacula, don’t waste your time and money going to a general doctor. Instead go straight to a foot and ankle specialist, or at least to a sports medicine doctor.

Unfortunately, the only solution likely to cure this problem is surgery. I have been through this surgery 2 times in the last three years (both times on the left ankle) and it was a hard to make the choice to go under the knife each time. It is an outpatient surgery, but it will leave you on bed rest for at least a week, and on crutches for at least a month. After the crutches come the walking boots, braces, and physical therapy. Expect to not be back to full capacity for at least 3 months.

Ankle injuries are hard to prevent if you are active. Even a mis-step while walking down the street can result in a very bad sprain. People with very loose joints (especially double jointed) are more prone to having a subluxing peroneal tendon. There are a few recommendations that I would make if you want to prevent an ankle injury. First, stretch your ankles before every workout (see video below). One stretch can be done by putting one set of toes up on a wall, with your heel on the floor a few inches away from the wall, and leaning into the wall. Another suggestion would be to use an ankle brace while you are exercising. Ask your doctor for more ways to strengthen your ankles, because an ounce of prevention is worth a pound of cure!

38 Responses

  1. Samantha

    Hi everyone!

    I’ve been looking for something with other people’s experiences of peroneal tendon subluxation for a long time, and I’m glad to have finally found it! My issues began as I was just going back to action after knee surgery my freshman year of high school. I’m a competitive synchronized ice skater, so I am very active and rely on my ankles a lot. Being your typical student-athlete, I didn’t tell anyone about my ankle pain, including my parents, until that November, 6 months later. I noticed a painful popping and some swelling but I thought by taping it myself and wearing a brace from Modell’s, I would be fine. Obviously, that didn’t quite happen, and I finally told my parents and went to the doctor. My orthopedic surgeon, who specializes in pediatric sports medicine, told me I had peroneal tendon subluxation but that he was optimistic about my chances for recovery.

    I was in an aircast walking boot for a month and a half, and then I moved to a brace and physical therapy. I felt some pain and my tendon occasionally popped, but after this treatment, I was much better than I had been before. I continued to wear the brace for the next year or so and eventually forgot about the issues since it seemed to be manageable. This past summer, I was an overnight camp counselor, which required me to moving around and on my feet a lot of the time. About two weeks in, I realized my ankle was swelling and becoming increasingly more painful, so I simply iced it and occasionally wore a brace I purchased at a nearby Wal-Mart. Then, on a hike with my campers, while on top of a rock on a mountaintop, I ran to get off to deal with a situation with two girls, and I rolled/twisted/did something unnatural to my right (bad) ankle. After this, my ankle was popping all the time, and was constantly swollen and painful. Still, I waited two more weeks before actually doing anything, at which point my boss finally forced me to leave camp for a day and go to a doctor.

    I went to the same orthopedist I’d gone to the first time around. I was told that not only did I have subluxation, but I had severe tendonitis, and, though he thought it was unlikely, I might have a minor tear of my peroneal. I was given a cortisone injection to help with the swelling, told to wear the boot again for an undetermined length of time, and given a prescription for physical therapy. My doctor also warned me that if all else failed, I would need surgery. However, he is extremely against the surgery. He says it would be a long recovery time and that the complications could be worse than the problem itself. This was mid-July, and I am almost done with my time in the boot and the first batch of PT. I still experience pain and swelling, and I am itching to be able to skate without extreme pain (he let me skate since I have custom boots that hold everything in place, on the condition that I don’t jump and stop if it hurts too much). I’m not sure what to do, but hopefully someone will see my experience and either be able to help or gain something from it!

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  2. Kay

    I too have an injured ankle. The orthopedic surgeon I went to immediately when the accident happened was afraid I have ruptured my peroneal tendon.Afte x-rays and an MRI it was determined that I did not. I was in a walking boot for five weeks then a brace and now physical therapy. However I feel no real change or relief. My ankle pops in and out every couple of days. The pain is excrutiating when it happens but only for a few moments, then its fine. I fell crazy because when I go to the doctor they say nothing is wrong and I have healed nicely. I hurt myself horseback riding when I took my leg of the horse and reconnected gentle to urge him forward. I tried riding six weeks after my injury and within about ten minutes I have subluxated the ankle again and couldn’t ride. Now it happens all the time. I am not sure what to do from here?

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    • Breanna M

      Im 14 in 9th grade and have to get surgery too because my foot doctor says that I have Peronial tendon subluxation. It all started about a year ago, and my ankle started hurting really bad, and it didn’t feel right. It kinda felt out of place, so I turned it one way and forced it back into place with my hands. It started happening more and more and one day it happened and when I tried putting it back into place, it wouldn’t go. I tried and tried and it just hurt really bad. I went to sleep, hoping tht it would go away and it didn’t. So that’s when I went to my doctor. Right away I had the same symptoms as the subluxation problem. The swelling, the brusing, the excruciating pain, the popping, the heat that I had to it, and the tenderness. He immediately sent me home with a brace that would help try to keep the peroneal tendon from popping out of the groove of my ankle bone. I went back in two weeks, and it helped with the pain, but as soon as I took it off, it didn’t work at all. Then I had to get a Cortizone shot straight into my tendon. I then waited two weeks until I had to go back. It started working for about a week and then it just died off and went back to the pain again. Now, I can’t ride my horse like I do everyday without the pain. Everytime I ride I am in so much pain. He said that I needed surgery I if wanted to do the things that I love doing again without the pain. He said that I would recover 100% in a full 90 days or more. After the surgery I get put in a hard cast for 6 weeks, then a boot, then maybe a brace and lots of physical therapy. It is going I ruin my whole show season with my horse, and my whole summer.

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  3. Whitney

    Hello, I have 9 year old twins and one of them was born with subluxation peroneal tendon. Since he was two months old and could put pressure on his feet when we held him up, you could hear the popping. At the age of 9 now he experiences tendinitis often. Today we were told he has very loose joints as well and will not be able to have surgery until he is fully grown. Now we will start reporting to physical therapy for in hopes he can have a normal childhood in sports and etc. It is a rare problem to have and I can never seem to find enough information on it that we can understand. Thank you.

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