Peroneal Tendon Subluxation

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Search Strategy

Key words: Peroneal Tendon Subluxation / Dislocation.
Information found at the university’s library (books) and websites: Pudmed, Web of Knowledge and Google Scholar.

Definition/Description

Subluxation or dislocation of the peroneal tendons is a disorder involving an elongation, a tear or an avulsion of the superior peroneal retinaculum [1]. There can be also subluxation of the tendons with an intact SPR (intrasheath subluxation) [2].

Clinically Relevant Anatomy

Anatomy of the Mm. peronei

The M. peroneus brevis and M. peroneus longus are contained in the retromalleolar sulcus on the fibula. The depth of the sulcus is variable and has been noted to be absent or convex [7]. The tendons are stabilized by a superior peroneal retinaculum. The SPR is formed by thickening of the superficial aponeurosis. A small fibrous ridge is occasionally seen originating from the distal fibula close to the origin of the SPR and increases the depth of the fibular groove. Distal to the fibula is the inferior peroneal retinaculum, which covers the tendons for about 2 to 3 cm distal to the tip of the fibula [3].

Epidemiology /Etiology

Peroneal tendon subluxation is more commonly encountered in skiing, but also has been reported in other sports [1] [4]. The peroneus longus and brevis tendons sublux or dislocate from the lateral retromalleolar groove. This results from a tear or avulsion or significant laxity of the SPR [4]. Some patients have a more chronic presentation and cannot recall a traumatic episode. Also congenital factors are reported, for example the sulcus or the ridge that helps deepen the sulcus can be too shallow or even absent or the SPR can be too loose [6]. Beyond the congenital factors, the most common mechanism is a dorsiflexory force on the ankle associated with concomitant forceful contraction of the peroneal tendons combinated with and eversion of the hindfoot [6].

Characteristics/Clinical Presentation

Classification of Disorders Involving the SPR:
There are three grades to classify the acute peroneal subluxation. (Eckert and Davis) [5], [7], [12]

Grade I:
The retinaculum, which is confluent with the periosteum on the fibula, is stripped away from the fibula, resulting in dislocation of the tendons.

Grade II:
The fibrocartilaginous ridge and the SPR is avulsed from the posterior aspect of the fibula.

Grade III:
bony avulsion of the posterolateral aspect of the fibula containing the cartilaginous rim and a flake of bone permitting the tendon to slide beneath the periosteum.

Later Oden described a fourth grade:

Grade IV:
The SPR elevated from the calcaneus

- Popping or snapping sensation on the outer edge of the ankle
- Tendons slip out of place along the lower tip of the fibula
- Pain, swelling or tenderness below/behind lateral malleolus
- Painful resisted ankle eversion
- Instable ankle [1]

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