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.
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!