Peroneal Tendon Subluxation and Dislocation, Surgery for

Indications: who needs surgery, when and why, and goals

Patients with acute or chronic peroneal tendon subluxation or dislocation are candidates for surgery to correct the problem. Some patients with acute injury may first try a cast for 6 weeks, because in up to 50% of patients, this is often successful in curing the problem. Some doctors feel that athletes with this condition, even with a recent, sudden injury, should be treated with surgery as soon as is reasonable after the injury, because the likelihood of success with nonoperative treatment is uncertain. The goal of surgery is to put the tendons back in the groove and help keep them in place to prevent further subluxation or dislocation. This is done either by tightening or reattaching the ligament-like tissue, called the retinaculum, that covers the groove that the tendons run through or by using other structures to replace or give additional support to the retinaculum. Sometimes the groove is shallow and also needs to be deepened.

Contraindications: reasons not to operate

• Infection of the ankle

• Inability or unwillingness of the patient to complete the postoperative program, which may include staying off the foot, or to perform the rehabilitation necessary

Risks and complications of surgery

• Infection

• Bleeding

• Injury to nerves (numbness, weakness, paralysis) of the foot and ankle

• Recurrence of subluxation or dislocation of the peroneal tendon

• Stretching out of the repair

• Continued pain and disability (inability to run, pivot, or rapidly change direction while running)

• Weakness of the muscles of the ankle

• Stiffness of the ankle

Technique: what is done

A variety of surgical procedures are available to treat this injury. One of the most popular techniques is to reattach the retinaculum to the bone of the outer ankle while tightening the retinaculum to remove any slack. Other techniques involve rerouting the tendons, using other tendons or ligaments to replace the torn retinaculum, or using bone to block excess motion by the peroneal tendons. If the groove that the peroneal tendons usually sit in is shallow, many surgeons will also deepen the groove.

Postoperative course

• Management after surgery varies.

• Keep the wound clean and dry for the first 10 to 14 days after surgery.

• Keep the foot and ankle elevated above heart level as much as possible for the first 1 to 2 weeks after surgery.

• You will be prescribed pain medications.

• Casting is often used for 4 to 8 weeks.

• Often, you will not be allowed to bear weight on the leg for between 2 to 6 weeks, followed by a short walking cast or brace for 3 to 6 weeks.

• Postoperative rehabilitation and exercises are very important to regain motion and then strength.

Return to sports

• Return to sports depends on the type of sport, the position played, and the quality of the retinaculum at the time of repair.

• A minimum of 3 months is necessary after surgery before returning to sports.

• Full ankle motion and strength are necessary before returning to sports.

When to call your doctor

• You experience pain, numbness, or coldness in your foot and ankle.

• A blue, gray, or dusky color appears in your toenails.

• Any of the following occur after surgery: increased pain, swelling, redness, drainage or bleeding in the surgical area or signs of infection (headache, muscle aches, dizziness, or a general ill feeling with fever).

• New, unexplained symptoms develop. Drugs used in treatment may produce side effects.

Do not eat or drink anything before surgery. Anything in the stomach, even water, makes general anesthesia more hazardous.

Figure 1

From Baxter DE: The foot and ankle in sport, St Louis, 1995, Mosby Year Book, p 32.

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