Peroneal Tendonitis/Tendon Subluxation?

Has anyone had what they felt like their ankle was subluxing again after surgery? A month ago I went hiking with nice tall boots on and and afterwards my ankle hurt even though I didn't roll it, and after wards when I put my finger on the tendon and rolled my ankle in circles it felt like it was subluxing again.

I saw my surgeon 5 days later and miraculously it stopped by then. It felt mostly fine since then until this tue when I saw my surgeon again for a follow up. When he checked my tendons by putting his fingers on them and having me make circles, I asked him if it felt like it was subluxing and he just said "everything feels behind the bone" which in retrospect was kind of an odd answer. When I got home I did the same test on myself and it felt like it was subluxing again. I checked it again today and it's the same thing. Hopefully it goes away or else my surgery might have been a failure.

My surgeon is very against groove deepening and has said there are papers showing there is a better post surgical result without it, although I can't find those papers online. Most everyone here has has it groove deepening though I believe. My surgeon is Dr. Adolph Flemister who is the division chief of foot and ankle surgery at the university of rochester if anyone else has had him.

Matthew, I am 4 years out from surgery. Since surgery I've hiked the Sierra High Route in 10 days and climbed everything from 5.13 to huge days out. Plenty of old nagging pains, bizarre new ones, and days that just bring tears of frustration to my eyes. My ankle will never be the same... But thus far it has not made me want to throw in the towel yet. At a certain point, you just have to accept that it's not going to feel right and just go do what you want to do anyway.

Josh Janes wrote:Matthew, I am 4 years out from surgery. Since surgery I've hiked the Sierra High Route in 10 days and climbed everything from 5.13 to huge days out. Plenty of old nagging pains, bizarre new ones, and days that just bring tears of frustration to my eyes. My ankle will never be the same... But thus far it has not made me want to throw in the towel yet. At a certain point, you just have to accept that it's not going to feel right and just go do what you want to do anyway.

This thread has been really useful for me so I just wanted to share my experience.

I tore my peroneal retinaculum bouldering indoors. In March I slammed my ankle on another foothold during an attempt at a dyno... when I hit the ground I could immediately tell something was off on the outside of my ankle. The two tendons normally tucked behind the ankle bone were now in front of it and could easily be pushed back with my finger. It didn't bode well - I went to A&E immediately and 8 hrs later was in a below-the-knee NWB cast. I was told to wait in this for 5 weeks until the NHS could book me in for ultrasound to figure out the damage.

I did a lot of reading and came to the conclusion that (1) with my level of activity, a conservative attempt at treatment would not really do much, and (2) an ultrasound is not sufficient to diagnose the extent of damage.

After 2 weeks in the cast, I paid for a private orthopaedic to remove the cast, tell me I don't need to be in a cast, and get me and MRI that showed a torn retinaculum and a longitudinal tear in the peroneus brevis tendon. Cost - £450. He said I would need surgery, so I slid back into the NHS and started waiting.

In May, I started cycling and bouldering again. The tendons would slide out of place during any abrupt motion, but otherwise I felt ok. Sadly, by October I was in a lot of pain on the inside of my foot. As it turned out, my arch had started to collapse due to overcompensation. As many people have said, get this fixed asap! Otherwise, everything else gets off track.

I had my surgery in early November. They cut part of the muscle off to make space for the tendons, tucked them in behind the ankle bone, and then attached my retinaculum with anchor sutures. I was in a NWB cast for 2 weeks, then straight into a FWB aircast boot for 4 weeks during which time I was constantly out and about and very active. I slept with an ankle brace on for 2 of those 4 weeks, then just free for the other two. Showered sitting in the bathtub.

At 6 weeks post op, I came out of the boot and was told to get back to life as usual, but to take it easy and wait for physio (on the NHS, that meant a 3 week wait). Needless to say, I did my own physio - thanks internet!

Progress has been great... at 7 weeks I had my first dance-heavy party, at 8 weeks I started cycling, and at 9 weeks (i.e. right now) I started doing yoga to increase flexibility and strength. I plan to get back to climbing at week 11-12. There's definitely tingly pins and needles, and some swelling but nothing that some elevation and massage cannot fix. I still have some way to go with the semi-fallen arch and the flexibility on eversion/inversion, but I am pleased to be on the mend.

Strongly suggest getting the surgery and getting on with your life!

I have seen two ankle specialist who told me that I need peroneal subluxation surgery soon, they also told me to stay off of my ankle because my tendon is close to rupturing. Today I was sent to see the surgeon, and he told me he wasn't comfortable  doing surgery because I am too young (I am 15). He gave me an ankle brace, suggested I take ibuprofen before I play sports (which is daily) and told me to go back to playing sports immediately, and to go on a run tonight! I asked him if my tendon could rupture and he said that it was a possibility, but he is suggesting a month or so of physical therapy. My ankles swell just walking to my classes, and I ice them, and elevate them everyday. My ankle pops out with almost every step I take and it is painful. I went on a walk today and the brace he gave me made my ankle pop more often! I am not sure if I should trust what the surgeon has told me, because it contradicts what other specialist have said, and doesn't feel right. I took four months off of sports to let my ankle heal before I saw a doctor, and my ankles got worse, which makes no sense because I barely walked and layed around all day. Please help. 

I am having the surgery in 10 days. The surgeon missed the subluxation the first time, and he did a brostrom repair. This time he is doing groove deepening, tendon repair and another brostrom. The initial injury was may 2, 2016 and the first surgery was december 8, 2016. The tendon pops a good 6 or 7 times a day, i also have pain under the foot, and at tje heel, and it looks like i have a cankle. Any advise for recovery?

Amanda,  My heart goes out to you.  I had my tendon repaired and brostrom procedure several years ago and I can't imagine going through two ankle surgeries. The best advice I have for recovery is to find a good physical therapist who will help you really break up all the scar tissue.  It's painful, but helpful in the long term.  I wish you the best of luck!

SarahD than you, now i cant even move it to either inversion or eversion, and they think a tendon has ruptured and my heel feels like a white hot knife is on it.

Does anyone have any advice on driving with this problem? Since my surgery on my left ankle for this a year ago, I have developed pain in the peroneal tendon in my right ankle and it makes driving quite painful. I don't want to have surgery again since the recovery was so long and painful last time, so if anyone has any tips on driving without so much pain that would be great.

This thread has been very helpful at making up my mind for going for surgery... guess I should fix it sooner rather than later. Thanks everyone for posting their experience! 

Any chance anyone on here is in Raleigh/Durham? This thread has been so helpful for me. I injured my ankle yesterday high-stepping on a gym route, had an audible pop and felt the tendons out of place (had to push them back behind the malleolus), haven’t been able to weight bear and have had continued subluxing with even small NWB motions. Have only had X-rays at urgent care at this point and will see ortho next week, but I am confident that this is what happened and this has made me feel so much better about the possibility of surgery as a solid choice in the long term.
On the off chance anyone on here is from my area, any ortho surgeon recommendations? I have an appointment with one who is a foot and ankle specialist, but no idea how much background he has with this particular surgery. 

I dislocated my peroneal tendons while bouldering this past October. I was trying to jump off of a high right foot to next hold and during the movement i heard/felt a pop in my ankle. I could put weight on it and there was not a ton of swelling. However the tendons would sublux over the bone whenever i turned my foot side to side(it was a painful and tingling sensation accompanied by a loud pop). After about a week I went and got it checked it out by an orthopedic surgeon. He highly recommended the surgery as soon as possible because the longer I waited the harder the repair would be and recovery time would increase. It is now about 8 weeks after the surgery and i am currently in a brace after first being put in a non weight bearing cast then a boot. I am so glad I got the surgery when I did so that I can get back to climbing hard. I know the recovery is long and it sucks, but on the bright side, my finger strength and power has improved immensely since the surgery as a result of me only being able to hang board and campus and am confident i will come back stronger than I was before. I have even integrated one foot climbing into training! This is the first thing I've seen with climbers suffering this injury so I feel better now that I am not the only one. Good luck with everybody else's injuries!

In response to Katie, I am from the Charlotte area so I am relatively close to your area. I went to OrthoCarolina foot and ankle center for my surgery if that is helpful.

Hi all. This thread has been an amazing resource for me so I thought I'd chip in to share my experience too.

I'm now 10 weeks out from surgery. The initial injury occurred while doing a very high step with my left foot at a weird angle (the foothold was quite a bit to the right side and the edge was also at an angle). The moment I weighted the foot a felt (and heard) the pop of my tendon dislocating, and immediately relocating. It did not feel like a serious injury at the time; I managed to finish the route and there was minimal pain or swelling that day and even the subsequent days - just pretty bad instability. The tendon subluxed maybe 5-6 times more over the next days, with slight pain and discomfort. After reading up online, I figured I had peroneal tendon subluxation and went to see a specialist, who confirmed that diagnosis. The specialist advised that there was a 50-50 chance of the injury healing itself and to see him again in 6 weeks. No MRI was ordered and no cast/boot was prescribed. From my research I knew that conservative treatment was not likely to be successful but the doctor was pretty stubborn - suspect it might have been a resource management decision given that I saw him through my country's public health system.

So for 5+ weeks I hobbled around - stayed off climbing and running but did some elliptical. Ankle seemed to improve very slightly but the instability remained. The tendon did not re-sublux at all during this time (albeit because I was very careful). As the follow-up appointment date approached I attempted some light top-roping to gauge my recovery. Unfortunately my tendon re-subluxed on a very ordinary move. And boy was it painful this time - at least of a couple of magnitudes more painful than the initial injury. I was not able to put weight on that foot for the 5 days which followed until my surgery.

The MRI revealed I had a Type II tear of the peroneal retinaculum - the retinaculum was almost completely lifted from the bone, but without any bone fragment having been torn off. Also, my groove was flattish - almost but not quite convex according to the doctor. The surgery itself involved both the reattaching of the retinaculum as well as groove deepening. The doctor had initially said I would 2 weeks in a splint and then to the boot, but following the surgery (rather the day following; I was hospitalised for one night), which he said went well, he put me straight into a boot, with partial weightbearing (i.e. two crutches).

I stayed at home for the next two weeks, mostly in bed. Was back at work (I have a desk job) after that. Swelling in my calf and foot during this time was the main problem, and caused quite a bit of pain and bad aches especially in the morning and at night. I graduated to a single crutch at I think about 2.5 weeks. At 4 weeks I was generally ok walking for short and level distances without crutches (i.e. just the boot). At 6 weeks the doctor said I could dump the boot - although I must say at the time my ankle did not feel ready at all for that. I still used a crutch for security for about a week more. I also wore high cut hiking boots for support which helped. I also started physio at this time. Exercises were supported heel raises and supported single leg stands. It was during the 6.5 weeks to current period (10 weeks) where I finally felt good progress towards normal was being made, when I could see the light at the end of the tunnel. Had to practically relearn how to walk - given that I had not been walking properly as early from 5+ weeks before my surgery. Doing the heel raises diligently helped alot I think.

Right now at 10 weeks I am quite ok walking at a moderate pace on level ground. Have been doing elliptical, weight machines and some light squats to try and get strength back. Doctor says to keep away from sudden loading at the moment, which he considered top-rope climbing to qualify as. There is still slight swelling in the calf especially towards end of the day but overall can see that it's getting better. Ditto for the surgery site, although I can still feel significant scar tissue(?) below the skin at the place of the incision. Range of motion is still not great eversion/inversion wise, but hoping it'll improve. I'm seeing the doctor again in a weeks time, at which time I'm hoping he'll clear me to get back to climbing! Really looking forward to getting back although there is some apprehension about how far I'll have regressed!

Sometime last week (about 13 weeks from surgery) I developed a pulsing tingling/numbness in my lower leg (around the front/outer part of my shin area). It occurs throughout the day and even through the night (even when lying down). The only time I don't seem to feel it is while walking/jogging. The tingling honestly came out of nowhere; I wasn't exercising or otherwise exerting myself when it started. It's been a week but hasn't improved, although function doesn't seem to be impaired at least for now - its just very irritating and distracting. Anyone else experience this?

matthew r wrote:

Does anyone have any advice on driving with this problem? Since my surgery on my left ankle for this a year ago, I have developed pain in the peroneal tendon in my right ankle and it makes driving quite painful. I don't want to have surgery again since the recovery was so long and painful last time, so if anyone has any tips on driving without so much pain that would be great.

You can buy extensions for brake and gas pedals. That's what I did when I tore my peroneal tendon. The extensions bring the pedals closer to you, so you can press on them without flexing your ankle.

Hey Folks!

First and foremost, I want to thank you all for providing your experiences on this forum. I've utilized it extensively over the past 6 months, and it's helped me immensely in navigating my own peroneal subluxation journey. Because I've had a pretty unique experience I figured I'd post it if only to benefit the next person obsessively searching the web post-diagnosis.

A bit of background-- I'm not a climber, but a pretty avid runner. About nine months into a running streak, I began experiencing lateral ankle pain and snapping that nearly ended the streak. I was diagnosed with peroneal subluxation shortly after by a podiatrist, and told I'd need eventual surgery. The funny thing was that I never experienced any trauma! In fact, both of my ankles have always painlessly "clicked" (they were subluxing-- I just didn't know it at the time. I thought all ankles just did that.). I sought out a second opinion with an orthopedic surgeon who also happens to be a female runner and we devised a plan to allow me to finish my year-long streak, and then go in for surgery.

I retired my streak at 370 days, and went into surgery the next morning. Initially things looked very promising-- no major tendon tears, just a really large and low-lying peroneus brevis muscle that was removed from my tendon sheath and a stretched retinaculum in need of some tightening. I was in a splint for two weeks, then moved to a boot and was walking in the boot about 4 weeks post-op. Unfortunately, almost as soon as I began weight-bearing, the subluxation returned. This time it was significantly worse-- things were tighter and very painful due to post-op healing. The subluxation was violent and loud enough that it could be heard the next room over. It was a mess.

I ultimately switched surgeons. My current surgeon is pretty much the go-to guy for failed ankle surgeries in my area. All I can say is WOW. This doc approached my condition holistically, considering my entire leg's alignment and structure. It turns out I have what's called intrasheath subluxation caused by about four minor anatomical differences that, when together, create a ticking time bomb. This was discovered via ultrasound and is much, much less common.  There was no trauma that exacerbated the condition, per se. It was just a matter of time due to my anatomy. My other ankle will almost certainly go the same route within the next decade or so.

I went into surgery again in early February. This time, my non-existent fibular groove was addressed and my now-damaged tendons reshaped. The entire area had to be cleaned out as it was a mess of scar tissue after all the subluxation post-surgery #1. I spent about 2.5 weeks in a splint, and have been NWB in a fiberglass cast for the last 5 weeks. I get the cast off tomorrow and will be in a boot until about 3 months post-op. This recovery has been longer and harder in part due to the trauma following sugery #1. There's still a chance some additional work on this leg may eventually be needed.

The reason I felt compelled to share this experience is because intrasheath subluxation can be tricky. It presents very similarly to the more classical form of peroneal subluxation, but may require more aggressive surgical intervention as it's often more related to one's anatomy than to an injury. If you can't recall a specific trauma that caused your initial subluxation, or if you have always been able to sublux your peroneals at will, I highly, highly recommend finding an orthopod trained in dynamic ultrasounds to pin-point the exact mechanics of your subluxation who will consider your entire anatomy. Most surgeons will only see intrasheath peroneal subluxation once or twice in their entire careers, and finding one familiar with the condition can make the entire process loads easier.

Good luck to all in their continued journeys!
El

I'm 1 month in to an ankle injury involving talus fracture and displacement (at risk, but, is recovering bone density--yay) ; almost lost medial skin due to partial thickness trauma, at least, but it pulled through and healed; torn ligaments; traumatized tendons under my foot (the most painful! Every day!). I'm in suspense at what's more to come. I know that not feeling anything at all is not ideal, so, I'm remaining hopeful and doing my best, or second to my best, at avoiding pain killers to be nice to my liver and invest in future pain tolerance. Respect to y'all that have months and years of pain in your ankles. That's gotta be absolutely haggard! 

1. I had surgery about three months ago. Feb.20, 2019
Two things were done. A marble-sized chunk of ossified bone chips were removed from the lateral left part of my left foot. And the peroneal tendon same left foot was repaired with the Bostrom Gould procedure. My peroneal damage was moderate shredding. I knew it was subluxating for years; I just didn't know that that was what it was called and that I was shredding my tendon. I have high pain tolerance and wasn't  seeking Medical Care until I couldn't walk anymore.
( The injuries probably began years ago after a lead fall in which my ankle struck a ledge, and subsequent many hiking sprains.)
Everybody is different but for me reading the research led me to believe that PT and rest would not do the job. The surgery to repair the tendon is the best hope for better function.
2. Recovery.
... folliwing all the rules and dr advice.
The first two months I drove a standard transmission car, and then a few weeks ago I moved back to my vehicle which requires my left foot to work the clutch.
I've also migrated back into my work which is a very physical landscaping supervisory job.
However I'm feeling discouraged would love to hear from someone else who's may be 6 months or a year down the road. I can walk but  by the end of the day I'm aching and limping. I ice everyday. I'd like to start hiking a little more aggressively. And begin top roping.
The surgeon released me for climbing ( but not bouldering! No problem there!)
Age 50s so I know connective tissue repair takes longer to heal at any age and especially as the decades go by.       Any input and encouragement is welcome!

PS Tennessee area

Just busted up my left ankle doing some indoor crack climbing. Had my left foot in an inverted position, put my weight on it, and heard a loud pop. Decided I should probably be done, so came down and tried to take a few steps, only to feel something pop out. After visiting urgent care, got predicted diagnosis of tendon subluxation. Currently in an ankle gel cast and also was given an air-cast boot to walk around in with crutches. Still can't put partial pressure on my foot in the air-cast on without my tendons popping out. Not sure if it means I don't have enough air in the cast to support my foot. Feeling anxious about possibly needing to get the surgery. My orthopedic NP wanted to see how things are after 6 weeks. Will see how things go~ ://

Edited:
Hello! Update about 1 year and 2 months post complete ligament tear and resulting peroneal tendon subluxation of the left ankle. Did not pursue the surgery route due to finishing up nursing school, finances, and other life circumstances that made it inconvenient to prolong recovery and have limited mobility. Haven't climbed at all since the injury... thinking that I might have to wait another year to climb still. I've tried to stay with PT and keep doing my ankle strengthening exercises. Currently, it's side stepping with theraband around feet and in place jumping. Some advice for people looking to exercise with this injury -- I've picked up cycling and no jumping kick boxing! Did lots of low impact high intensity workouts and cycling during first half year of recovery. Then transitioned to careful hopping and gradually jumping. I've avoided my usual court and team sports activities just to prevent further injury and tearing. Also always wear a support brace during outdoor activities. Walking is a good activity to start with avoiding uneven surfaces. I sometimes still have feelings that my tendon is not secure with certain movements and positions that my foot was in when my injury occurred. I often wonder where I would be if I had gotten the surgery right away, but I can't complain because I can walk around for the whole day for work, bike, and do home workouts. Dreading the recovery period again if I decide to pursue surgery in the future. I'd like to be able to jump, run, walk, play groups sports without having to worry about my ankle and maybe also climb again. Maybe that's all worth the time of rehab and recovery again?