Peroneal Tendonitis/Tendon Subluxation?

I got an MRI at the start which verified I'd definitely done some damage to my retinaculum, but it wasn't completely detached. This also showed that I had a fairly flat ridge on the back of my malleolus, so I'm not terribly pre-disposed but it's definitely not helping.

My doctor is supposed to be one of the best in Boston for this, but I get the feeling he may be trying to reduce his rate of surgery, or protect some form of surgical statistic. I probably should have pushed him harder to just do the surgery. I'd already be out of the cast at this point.

So reading this has made me super depressed. I've got pretty much all those symptoms spot on...

I was climbing in a gym last week, about to clip the chains and my foot slipped on a hold. Not quite sure what happened. But I didn't fall. I tried to weight the foot on the same hold, and it hurt like a biotch. Got some ice and tried to climb mostly one-footed the rest of the day. Hobbled around a bunch. Ankle swole up like crazy that night. Then this weekend I felt a little better, so I decided to do some easy trad climbing. Almost every time I tried to weight my ankle it would pop and be really painful. Saw a doctor earlier that day who took an x-ray and said I was fine.

Now I can feel it slip out and I can push it back with my fingers. It's been 4 days. This Friday I'm scheduled (and paid the 525$ fee) to do a single pitch instructor course... I'm also very active and go nuts if I can't work out.. Does this mean I need surgery? I also have a trip to the tetons in August, not to mention my career choice kinda banks on me being active.

Gnarly pics BTW !!

@topropetoughguy123 - I would recommend going directly for the surgery. As a follow-up from my last post, I tried the non-surgical route. All it did was cause me to be super cautious for a bit and take it easy with anything active. I eventually blew out my (partially) healed retinaculum slipping on some ice. Wasted about 6 months of my time.

I just switched doctors and got the surgery. The doctor I switched to is the chief of the Foot and Ankle Surgery Department at Mass General in Boston. The surgery only took about an hour and half. They removed some slight fraying from my tendon (small tears caused by the tendon sliding over the bone), reattached my retinaculum with stitches and an anchor, and performed a groove deepening. I was in a splint for two weeks and have 4 weeks in a hard cast (partial weight bearing). Total of just 6 weeks on crutches then I go straight into PT. I'm told I can go back to sports 6 months after the surgery.

Wow thanks for the speedy response guys!! Yeah I'm trying to figure out everything so I can take some time off. In your situations it seems like most of you had chronic subluxation, not acute? I've never had this problem in my life it was just due to that injusry last week. My SPI instructor said it wouldn't be a problem if I didn't do any climbing. So hopefully I can get it immobilized before the end of the week. I'm in upstate new York, but I guess all the good orthos are over in Burlington Vermont. Where are you located Jim? It seems like a lot of people here from NYC area

Also, for the mean time does anybody know any home remedies for keeping it from dislocating? I tried pressure taping it backwards and that seems to work sorta...

Do not mess around with home remedies, tape, braces and such. The medical community is clear on this one and the chance of you busting it up again is pretty much guaranteed. My advice wold be to find a reputable foot doctor and have him look at your MRI. This injury will not show up on xray.
As far as mindset, Jim said it best. Shift your mindset from next weekend, month, or this season. This will only continue to get worse if you leave it. Not only does it hurt like a mother every time it pops, bit you do damage to the tendon with every dislocation. The recovery is significantly different if you have to heal you repaired retinaculum, vs having to heal your ruptured tendons as well. Bite the bullet and do it.
Here is my time line of return to activity so maybe it'll help you see that it's not that grim:
I went back to the activity exactly 12 weeks after surgery (surgery was on September 11, 2015). My first outing was ice climbing and that went well. I went skiing that same weekend and that was shaky at best. I remember having to call it after about 5 blue groomers, but I was super surprised that it went that well. Rock climbing came back slowly, but that had to do more with me trusting the foot than it being able to perform. I stayed in PT until January doing sports specific recovery (it took a while to be able to do any kind of jumps, or single legged heel raises on the bad foot - once those came in, I quit PT in the middle of Jan).
Skiing also came back slowly and was mainly conditions dependent. To help you get an idea where I am now, I have more than 50 ski days between the resorts and the backcountry since December. It started slow, but now I can handle 5-6-7k foot days in the backcountry or 25k lift served before the foot complains. Hiking-wise, about a month ago, I did a 14er that was about 20 mi round trip and that was kind if hard on it but that was also while carrying camping gear. Climbing-wise, I was probably on pre surgery level by February physically, but mentally, I'm still getting there with lead clumbing. The foot itself is hardly a factor and probably the main issue is fitting back into my tight aggressive shoes of yesteryear since the ankle is a bit bigger than the other one. Oh, and I went Crack climbing in Indian Creek few weekends ago - it was no picnic on the foot, but it's not like the healthy one was enjoying it either. One thing I can not yet do is run. Running stresses it out big time and I can't manage more than few strides, but I feel it getting better in that department too.
I guess the purpose of this was to show you that the life goes on and it comes back to normal sooner than you realize. I remember the cabin fever that raged during the first 6 weeks and thinking how improbable the doctors 12 week time line was. I remember a lot of inverted push ups from the back of the couch while keeping the foot raised. Oh, and hallucinogens. They sure make the days go by faster.

@gsule nice recovery story. I'm going to see the ortho today. I guess it just sucks to see all the fitness I've been building for the summer go to waste. That sucks you still cant run. I hope you get better soon.
As far as the taping thing goes, I was just looking for a way to keep it from slipping since I don't have crutches and the doc might not cast it. It's hard without a car and living a 20 min walk from work/school haha. This is literally the dumbest injury. Although I always felt bad for the ACL/PCL crowd

topropetoughguy123 wrote:@gsule nice recovery story. I'm going to see the ortho today. I guess it just sucks to see all the fitness I've been building for the summer go to waste. That sucks you still cant run. I hope you get better soon. As far as the taping thing goes, I was just looking for a way to keep it from slipping since I don't have crutches and the doc might not cast it. It's hard without a car and living a 20 min walk from work/school haha. This is literally the dumbest injury. Although I always felt bad for the ACL/PCL crowd

i've had luck taping mine for snowboarding using a j pad piece of foam taped around the bone to hold the peroneal tendons in, followed by an aggressive ankle wrap job. It still pops in and out but reducing it by ~70%. Something for the interim but by no means a solution. I also use leukotape instead of normal athetic tape

redlude97 wrote: i've had luck taping mine for snowboarding using a j pad piece of foam taped around the bone to hold the peroneal tendons in, followed by an aggressive ankle wrap job. It still pops in and out but reducing it by ~70%. Something for the interim but by no means a solution. I also use leukotape instead of normal athetic tape

Did you have surgery? I had a MRI which did not show anything, and the ankle surgeon said my groove looked deep enough, I have a cross between peroneal tendinitis and mild peroneal subluxation. He said it wasn't that bad, it only pops occasionally, but is pretty painful most of the time. Compared to some youtube videos I have seen of people showing their tendon popping it doesn't seem as bad.I have the same level of mild subluxation on the other ankle but it doesn't hurt. I go through periods where it seems okay and if I overdue it then it flares up again. I have tried taping it which helps and I wonder If I can avoid surgery if I keep it taped up as I really don't want to have surgery.

There is not much info about this injury online compared to other injuries which makes me think it's pretty rare, or other people are just tuffing it out maybe?

matthew r,
My initial ankle injury and surgery were over 10 years apart. I rolled my ankle and dislocated the peroneal tendon (popped over the lateral malleolus) when I was in college. I went to the doctor and was only diagnosed with an ankle sprain. For the next 10 years or so I rolled my ankle a few times a year and each time the peroneal tendon would also pop over the lateral malleolus. This sounds worse than it really was. I could walk on it immediately and was back to full activity in a day or two. Josh Janes made a good analogy of a rope under tension. Eventually I tore the peroneal tendon to the point where I couldn't do any activity and had surgery: Brostrom procedure, tendon and retinaculum repair.

So, my point is that you may be able to postpone surgery, but know that you are likely damaging your ankle more and more each time the tendon pops out of place. That said, I did read a medical journal article a few years ago that showed a large number of cadavers that have torn peroneus brevis tendons. I found the article if you're interested...

ncbi.nlm.nih.gov/pmc/articl…

sarahd wrote:matthew r, My initial ankle injury and surgery were over 10 years apart. I rolled my ankle and dislocated the peroneal tendon (popped over the lateral malleolus) when I was in college. I went to the doctor and was only diagnosed with an ankle sprain. For the next 10 years or so I rolled my ankle a few times a year and each time the peroneal tendon would also pop over the lateral malleolus. This sounds worse than it really was. I could walk on it immediately and was back to full activity in a day or two. Josh Janes made a good analogy of a rope under tension. Eventually I tore the peroneal tendon to the point where I couldn't do any activity and had surgery: Brostrom procedure, tendon and retinaculum repair. So, my point is that you may be able to postpone surgery, but know that you are likely damaging your ankle more and more each time the tendon pops out of place. That said, I did read a medical journal article a few years ago that showed a large number of cadavers that have torn peroneus brevis tendons. I found the article if you're interested... ncbi.nlm.nih.gov/pmc/articl…

Did your ankle feel unstable before your surgery or only after you torn your tendon? Was it a rupture or a split tear and how did you know you tore it? I was reading another article where a pysical therapist said : I have seen multiple asymptomatic peroneal subluxations following repeat ankle sprains in basketball players and rugby players who don't seem to be too affected by it in the long term." It's here physiobob.com/forum/patient…

I wonder why some people have pain and others don't. Out of curiosity I looked at the ankle of a 62 year old friend of mine who had a minor high ankle sprain a couple years ago and did the test my doctor did to see if the tendon is subluxing and to my surprise it was on her, maybe even worse than mine is, and had a snapping sound. She hears no snapping when she walks. She has no pain in that area at all and only occasional minor pain in the upper middle of the ankle where the high ankle sprain was. I wonder why this is?

Anyone know? Also I was thinking doesn't the tendon rub over the bone on your knuckles when you open and close your hand, how come that tendon doesn't tear from that.

matthew r wrote: Did you have surgery? I had a MRI which did not show anything, and the ankle surgeon said my groove looked deep enough, I have a cross between peroneal tendinitis and mild peroneal subluxation. He said it wasn't that bad, it only pops occasionally, but is pretty painful most of the time. Compared to some youtube videos I have seen of people showing their tendon popping it doesn't seem as bad.I have the same level of mild subluxation on the other ankle but it doesn't hurt. I go through periods where it seems okay and if I overdue it then it flares up again. I have tried taping it which helps and I wonder If I can avoid surgery if I keep it taped up as I really don't want to have surgery. There is not much info about this injury online compared to other injuries which makes me think it's pretty rare, or other people are just tuffing it out maybe?

So I had subluxation on both ankles from seperate injuries. I've had surgery on only 1 of the ankles. That ankle is fine now. For the one I didn't have surgery on, I can get away with taping, but only for certain activities where the foot remains pretty immobile, mainly snowboarding. I can't cut hard on it in regular shoes even taped, like for soccer or basketball, but its ok for climbing. If it is painful though, then you are causing significant inflammation and probably some scarring, which will give you trouble eventually. If it hurts I recommend getting the surgery. It sucks but it is better afterwards almost 100%

redlude97 wrote: i've had luck taping mine for snowboarding using a j pad piece of foam taped around the bone to hold the peroneal tendons in, followed by an aggressive ankle wrap job. It still pops in and out but reducing it by ~70%. Something for the interim but by no means a solution. I also use leukotape instead of normal athetic tape

Where did you get leukotape? I have seen people use it in Australia but I haven't seen it for sale in the US. Is it different than KT tape? I want to try using a piece of foam too, what did you use to make the j shaped piece? I was thinking of using moleskin but I'm not sure that would be thick enough.

matthew r wrote: Where did you get leukotape? I have seen people use it in Australia but I haven't seen it for sale in the US. Is it different than KT tape? I want to try using a piece of foam too, what did you use to make the j shaped piece? I was thinking of using moleskin but I'm not sure that would be thick enough.

Amazon It's the opposite of KT tape: non-stretchy (& super sticky). Great for finger/wrist support taping & blister prevention

reboot wrote: Amazon It's the opposite of KT tape: non-stretchy (& super sticky). Great for finger/wrist support taping & blister prevention

What did you use for the J shaped piece of foam?

matthew r wrote: What did you use for the J shaped piece of foam?

Just like a neoprene foam, you can get it from a PT/trainer. Its like a dense 1/8" thick closed cell foam

Hey guys I figured I'd throw in an update since it's been some time.

2 days after injury, went to doc, got an x ray. Instructed to ice and elevate. Went climbing that day and felt pops.

6 days after injury, got an appt with an orthopedist. Confirmed it was subluxing and casted me with crutches. More x rays.

14 days after injury, saw another orthopedist, who popped it out a few times, casted me (terrible job) and had more x rays. (Seriously guys?)

28 days after injury saw a competent orthopedic surgeon ankle and foot specialist. Saw that tendons did not pop out anymore, walked around a bit. Saw that I lost some serious calf gains but at least it was healing okay. Instructed to come back in 6 weeks to get my new cast and boot off to see if it has healed. I'm feeling good about this. Surgery, maybe. But for sure it seems like the retinaculum is starting to heal.

Big takeaways from this- go directly to an ankle specialist orthopedic surgeon. Have an MRI if possible. I'll see ya guys in 3 weeks.

redlude97 wrote: So I had subluxation on both ankles from seperate injuries. I've had surgery on only 1 of the ankles. That ankle is fine now. For the one I didn't have surgery on, I can get away with taping, but only for certain activities where the foot remains pretty immobile, mainly snowboarding. I can't cut hard on it in regular shoes even taped, like for soccer or basketball, but its ok for climbing. If it is painful though, then you are causing significant inflammation and probably some scarring, which will give you trouble eventually. If it hurts I recommend getting the surgery. It sucks but it is better afterwards almost 100%

For the ankle you didn't have surgery on, do you have to tape it up all the time, or just when doing sports?

How much pain were you people in before surgery? Because I am in alot of pain and can't stand or walk more than 50 feet or less without alot of pain or stand for more than 30 seconds.

I went to a ankle surgeon and a podiatrist and they told me it was peroneal subluxation. I had a MRI too. I don't get why I'm in so much pain if everyone else can walk on it. Did it not hurt you at all or do I just have a low pain tolerance?