The patient in this scenario has chronic peroneal subluxation. Radiographs are often normal in this condition. On physical exam, a consistent finding is subluxation of the tendons with resisted dorsiflexion and eversion of the ankle. This is most likely secondary to a disruption of the superior peroneal retinaculum (SPR). After a trial of non-operative management, surgical options include repair of the SPR, with or without fibular groove deepening.
Philbin et al reviewed peroneal tendon injuries. As 40% lead to chronic lateral ankle pain, they emphasized an accurate physical exam. They concluded that low-demand patients do well with a nonsurgical approach while high-demand patients may benefit from surgery.
Heckman et al reviewed operative techniques for peroneal disorders. They determined that operative repair consists of surgical repair of the (SPR) with or without fibular groove deepening for subluxation. Primary repair of the tendon is indicated for tears <50% while tenodesis is indicated for tears >50%.
The video depicts the clinical appearance of the peroneal tendons subluxing with ankle dorsiflexion.
1. He has already completed a trial of non-operative management.
2. A fibular shortening osteotomy is not the treatment of this condition.
3. His exam is not consistent with an ATFL injury.
4. His exam is not consistent with a CFL injury.
Philbin TM, Landis GS, Smith B. Peroneal tendon injuries. J Am Acad Orthop Surg. 2009 May;17(5):306-17. Review.
PMID:19411642 (Link to Abstract)
Heckman DS, Reddy S, Pedowitz D, Wapner KL, Parekh SG. Operative treatment for peroneal tendon disorders. J Bone Joint Surg Am. 2008 Feb;90(2):404-18.
PMID:18245603 (Link to Abstract)