Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Peroneus Tendon Dislocation

SYMPTOMS

In the acute phase, there is sharp pain and swelling/bruising over the lateral, posterior part of the ankle and distal fibula, after previous sprain. The patient will have a sense of weakness and instability of the ankle and may recall one or two snapping sounds from the time of the injury. If there was one snap, it may be a tear. If there were two, dislocation and reposition of the tendon should be suspected.

AETIOLOGY

The peroneus brevis and/or longus can dislocate over the tip of the lateral malleoli from its groove during an inversion-plantar flexion ankle sprain. In the acute situation, a tear of the overlying retinaculum will cause sharp pain and a snapping sound and the tendons can rupture longitudinally while dislocating over the malleoli. The dislocation can be permanent but often the tendons reposition themselves spontaneously, which makes the diagnosis difficult.

CLINICAL FINDINGS

There is distinct tenderness on palpation posterior to the tip of the lateral malleoli over the peroneus retinaculum and localised bruising and swelling, sometimes effusion. Rarely, the dislocated tendon can be palpated on the lateral malleoli.

INVESTIGATIONS

X-ray is normal. MRI may show localised oedema and swelling over the lateral retinaculum or occasionally a tear in one of the tendons. Longitudinal tendon ruptures may be difficult to see unless there is a complete tear, which is very unusual in athletes. Ultrasound examination is very valuable, since a dynamic assessment is possible and subluxation can be provoked by plantar flexion-eversion.

TREATMENT

In the acute phase RICE is advocated. An athlete with a dislocated tendon can hardly walk. Early proprioceptive training and weight-bearing exercise is sometimes allowed. Rehabilitation is usually curative and the athlete can resume sport within two to three weeks, occasionally using a brace or strapping for the first six to twelve weeks. In professional athletes with high demands, surgery may be indicated, including inspection and treatment of ruptures and fixing of the retinaculum, since chronic subluxations can disable the athlete for a long time. Six to twelve weeks after surgery, the athlete can return to sport, using a brace.

REFERRALS

Refer to Dr Kevin Yip, an orthopaedic ankle surgeon for early consideration of surgery or immobilisation preferably while the injury is acute or within two weeks.

EXERCISE PRESCRIPTION

Rest will not help so allow all kinds of sporting activities using well-fitting shoes but avoiding impact, such as running and jumping.

EVALUATION OF TREATMENT OUTCOMES

Monitor decrease of clinical symptoms and signs.

DIFFERENTIAL DIAGNOSES

Syndesmosis ligament tear (positive syndesmosis test); MT V fracture (tenderness on palpation, positive X-ray; Fibula fracture (positive X-ray).

PROGNOSIS Excellent-Good.

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