The peroneal tendon passes posteriorly to the lateral malleolus which is located on the external side of the ankle. A tough connective tissue, known as the peroneal retinaculum, holds the peroneal tendons in place. If the peroneal retinaculum is torn due to any injury, then the peroneal tendons move out of their place and slip over the lateral malleolus on the external part of the ankle. This condition is known as peroneal tendon submuxation or dislocation. The peroneal tendons continue to remain in the dislocated position or they may return to their previous position on their own. As the peroneal retinaculum is torn, the tendons are inclined towards recurrent dislocations in the future.
About the Peroneal Tendons
A tough connective tissue called as the peroneal retinaculum holds the peroneal tendons in place. If the peroneal retinaculum is torn due to any injury, then the peroneal tendons move out of their place and get displaced over the bony prominence on the external part of the ankle. This condition is known as peroneal tendon subluxation or dislocation. Recurrent peroneal tendon subluxation or dislocation cause inflammation. Peroneal tendon subluxation or dislocation is common in athletes who have unstable ankles. Another causative factor is the tightness in the muscle belly of the peroneal tendon. This tension can be released by deep tissue massage which is extremely helpful.
Causes of Peroneal Tendon Subluxation or Dislocation
Unnecessary inversion of the foot usually in conjunction with moving the knee forward over the toes (dorsiflexion) while weight bearing. Peroneal tendon subluxation or dislocation also commonly occurs with ankle sprain and with activities which require rapid changes in direction such as basketball, football and volleyball. Peroneal tendon subluxation can also occur with playing sports on uneven surfaces.
Symptoms of Peroneal Tendon Subluxation or Dislocation
- Pain upon pronation of the soles of the feet is one of the symptoms of peroneal tendon subluxation or dislocation.
- Audible snap or a sound during the injury.
- Pain or tenderness posterior to the lateral malleolus.
- Patient suffering from peroneal tendon subluxation or dislocation will have inability to bear weight.
- Swelling may be present.
- Bruising may be present.
- There may be stiffness present.
Treatment of Peroneal Tendon Subluxation or Dislocation
- Rest, Ice, Compress and Elevate (R.I.C.E.) technique should be applied on patients suffering from peroneal tendon subluxation or dislocation.
- After the inflammation has subsided, gentle stretching should be done.
- Sports massage techniques are extremely helpful in releasing the tension in the peroneal muscle due to peroneal tendon subluxation or dislocation.
- A plaster cast can be applied for 3 to 4 weeks for rapid healing following peroneal tendon subluxation or dislocation.
- Patient suffering from peroneal tendon subluxation or dislocation should enroll in a rehab program.
- Surgery for peroneal tendon subluxation is required if the damage is severe to repair the tissue that keeps the tendon in place.
- Strengthening and balance exercises should be done to restore normal function of the ankle after the surgery for peroneal tendon subluxation or dislocation.
What is the Recovery Time for Peroneal Tendon Subluxation or Dislocation?
When it comes to the recovery phase post-treatment for Peroneal Tendon Subluxation, the recovery period or the healing time can be variable depending on the severity of the injury. Since the basic treatment for peroneal tendon subluxation or dislocation is casting hence healing period starts once the cast is fitted for the patient and once the patient is through with the casting treatment then focus is put on strengthening and achieving normal range of motion of the injured leg so that the patient can return back to normal activities at the earliest possible time frame. The initial phase of rehabilitation for peroneal tendon subluxation or dislocation starts with casting which is done for a period of about six weeks. During this period the leg is completely immobilized so as to allow the subluxed peroneal tendon to heal. Once cast is taken off, the patient has to be in a walking boot for a period of about three weeks. So all in all it takes approximately 10 weeks to heal from Peroneal Tendon Subluxation injury. Once healing is complete, a rehabilitation procedure is formulated by the physical therapist to facilitate strength and range of motion of the injured leg. The exercises include range of motion exercises and strengthening exercises. The physical therapy for peroneal tendon subluxation will continue until the patient has achieved at least 90% of the range of motion and strength in comparison to the normal ankle. The patient is then allowed to perform certain activities in a brace. The patient may stay in a brace for up to as long as six months depending on what type of treatment the patient has had. One important aspect of Peroneal Tendon Subluxation rehabilitation is proprioceptive rehab as recurrent ankle sprains tends to damage the peroneal tendons even more. It is also important to note here that if a sportsman returns to competitive sports without adequate rehabilitation for peroneal tendon subluxation, then it may prove costly as it may destabilize the ankle and make the individual disabled and unable to participate in competitive sports again.
What are the Exercises that One Can Do following Treatment of Peroneal Tendon Subluxation?
Some of the exercises that an individual can do following a Peroneal Tendon Subluxation / Dislocation are:
Towel Stretch Exercise To Help Recover From Peroneal Tendon Subluxation or Dislocation: To do this exercise, sit on a chair or a stool with the injured leg stretched out. Place a towel around the toes and the ball of the foot with the ends of the towel in each hand. Now gently pull the towel up towards the chest all the while keeping the leg straight. Maintain this position for about half a minute. Repeat this exercise about three times per session and do this about three times a day. Once there is not enough stretch felt on the calf with this exercise, the patient may advance to the below mentioned exercises for further rehabilitation.
Rehab Exercise for Peroneal Tendon Subluxation- Standing Calf Stretch: To do this exercise, you need to stand facing a wall with the hands kept at the eye level. Now, keep the injured leg a bit backwards with the heels on the floor. Keep the uninjured leg forward with the knee bent. Now, turn the injured foot gently inwards. Gently, lean into the wall until a stretch is felt at the back of the calf. Maintain this position for about half a minute. Come back to the starting position and repeat the exercise. Do this exercise at least three times a day.
Rehab Exercise for Peroneal Tendon Subluxation- Standing Soleus Stretch: To perform this exercise, stand facing a wall with the hands on the wall at about chest height. Place the injured leg backwards with the heels firmly on the floor and the other leg forwards with the knees bent. Now, turn the injured foot inwards. Bend the injured knee and lean slightly towards the wall until a stretch is felt in the calf of the injured leg. Maintain this position for about half a minute and repeat this exercise about three times a day.
Achilles Stretch: Stand on the steps of a staircase with the ball of the foot in contact with the stair. Now try and reach for the step below with the heel until a stretch is felt on the arch of the foot. Maintain this position for about half a minute and come back to the starting position. Repeat this exercise about three times and do it about four times a day.
Heel Raise Exercise for Peroneal Tendon Subluxation or Dislocation: To perform this exercise, you need to stand behind a chair with the foot firmly planted on the floor. Using the support of the chair try and rise up on the toes as much as possible and hold the position for about 10 seconds. Then come back to the starting position without holding on to the chair if you can. When the pain becomes less when doing this exercise try standing on the injured leg and repeat it about 20 times. Take at least half a minute rest in between repeating this exercise.
Step-up: To perform this exercise, stand with the injured leg on a support which is kept about 5 inches high like a block of wood. Keep the other foot planted firmly on the floor. Now gradually transfer the weight from the uninjured leg to the injured leg slowly. Try and straighten the injured leg while the other leg comes off of the floor. Come back to the starting position by bending the injured leg and slowly planting the uninjured leg back to the floor. Do this about three times and perform this exercise about 10 times a day.
Resisted Ankle Eversion: To do this exercise, sit with both legs stretched out in front of you with the feet about a shoulder length apart. Take a towel or a rubber tune and place it around the injured leg such that the tube or the cloth surrounds the arch of that foot and is wrapped around the outside part of the uninjured leg. Take one end of the towel or cloth with the hands so that there is tension created. Turn the foot of the injured leg in an upwards and outward direction making sure that the other foot does not move and allow the cloth or the tube to stretch as much as possible such that the leg is stretched. After doing this return to starting position and repeat the exercise at least five times. Do this exercise at least 10 times a day.
Balance and Reaching Exercises: To perform this exercise, stand near a chair or a support with the injured leg away from it. Now, stand on the injured foot and bend the knee just a little bit. Now, try and raise up the arch of the foot while keeping the toe down. Now try and move the hand closer to the chair or the support by bending down but making sure not to bend the knee more. Repeat this maneuver about 20 times and do this about five times a day.