Peroneal subluxation

Findings

There is a history of a click or flick, plus or minus pain, over the lateral maleolus, and a feeling of insecurity of the ankle. Subluxation of the tendon is reproduced with resisted eversion of the foot and can be seen, and palpated, as the tendon jumps forward onto the lateral maleolus.

Cause

The peroneal tendon subluxes anteriorly from its groove behind the lateral maleolus.

Treatment

Minor episodes may be restrained with padding and strapping over the fibula, which functionally deepens the peroneal groove. Perhaps orthotics, to correct oversupination, may help. If these measures cannot control the tendon then surgery to deepen the peroneal groove is required.

Sports

a)      Rehabilitate through the Achilles ladders, but, after the sprinting stage, add figure-of-eights and shuttle run drills. Sidestep and cross-over drills should be started as early as possible.

b)      Karate, muay thai, taekwondo and soccer – some kicks with the outside of the foot may cause problems

Not common but sometimes traumatic. If minor, it is worth a try with conservative padding before considering surgery.

"Concise guide to sports injuries, 2^nd edition",Churchill Livingstone, Malcolm T.F. Read,  foreword by Bryan English