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Peroneal Subluxation

Discussion in 'Biomechanics, Sports and Foot orthoses' started by bdnelson, Jun 16, 2006.

  1. bdnelson

    bdnelson Welcome New Poster


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    Any ideas on peroneal subluxation, I am looking for nonsurgical options. Patient with history of chronic ankle sprains now experiencing subluxation with running. Thanks!
     
  2. I have tried all nonsurgical options. Surgery is a predictable means of curing the problem and will be the only thing, in my clinical experience, that does any useful good.
     
  3. Dieter Fellner

    Dieter Fellner Well-Known Member

    Kevin,

    how do you approach this problem surgically ?
     
  4. The orthopedic surgeon I work with and I have done a few of these with excellent results and the more gifted podiatric surgeons I know do these also much more frequently than I do with excellent results. Generally, and briefly, the retinaculum is tied down by bone anchors to prevent the peroneal tendons from subluxing anteriorly on the lateral fibula without regrooving the posterior fibula.
     
  5. Dieter Fellner

    Dieter Fellner Well-Known Member

    bone anchors

    Kevin, thanks for your reply . Do you have a reference for a detailed account of this I can study?
     
  6. Dieter:

    I still have all my surgery reference books in boxes from my recent home move. However, if I remember correctly, I think that both Ken Johnson's color atlas of foot surgery and Tom Chang's book on foot surgery have sections on this procedure and with their color photos greatly help visualizing the procedure. The surgery textbooks by Jahss and McGlamry also have sections on this procedure if I'm not mistaken. Here's a good internet reference http://www.wheelessonline.com/ortho/peroneal_tendon_dislocation

    You would probably get some excellent replies by some of the more respected podiatric surgeons in the States if you asked the same question in Barry Block's PM News e-mail newsletter. http://podiatrym.com/pmnews.cfm

    Hope this helps.
     
  7. Admin2

    Admin2 Administrator Staff Member

  8. Dieter Fellner

    Dieter Fellner Well-Known Member

    Thanks Kevin.... I am on the case.
     
  9. Atlas

    Atlas Well-Known Member


    Strapping the lower leg (clockwise for right leg; anti for left) with an elastic adhesive, so that the tendon is encouraged to stay behind the distal fib, does help with clicking/pain etc.
     
  10. Ron:

    I have tried this technique but have been unsuccessful in having it make much difference. Have you found it is able to reduce the pain and clicking during running and can it be tolerated enough to be used on a daily basis for chronic sufferers?
     
  11. Atlas

    Atlas Well-Known Member


    As you know, the skin does not tolerate tape too well on a daily basis; and skin-sensitivity does vary from person to person, and region (plantar v. dorsal) to region.

    Hence, what I do is instruct the patient to prioritise their week. For instance, do their aggravating activities skewed to one part of the week; or (run) on alternate days. At least that way the skin can settle.

    I have found that it does make enough of a difference. Obviously, the limiting factor in this type of taping technique is neuro-vascular compromise. If the latter is catered for, and if the tape is applied when the tendon is in its 'proper' position re-assessment testing should improve. I don't think the tape is magically holding the tendon specifically. It may be that the increased compression between the dermis and the distal fibula, restrain the tendon from slipping over. With that in mind, I might fiddle with an ankle air cast next time????

    I am not advocating a long-term solution from the tape by any stretch. But, if applied properly, the patient can enjoy less discomfort with previously provocative activity.
     
  12. Unfortunately, most of the athletes I treat would not accept being relegated to only every other day workouts. I suppose I will continue to recommend surgical treatment since, I have found it to be very successful, allowing the patient to resume normal, daily, aggressive physical activity generally within 3 months after the surgery.
     
  13. zenjudo

    zenjudo Active Member

    Is it always necessarily to diagnose subluxation with MRI or US or is clinical diagnosis sufficient enough?

    cheers
     
  14. The problem with MRI and US is that, in some patients, the peroneal tendon doesn't sublux until the ankle is dorsiflexed and the peroneal muscles are actively contracting. Therefore, clinical diagnosis is not only sufficient but, as far as I'm concerned, the preferred method of diagnosis since MRI scans and US scans have the potential to have false-negatives, unless they are done with the peroneals under tension and with the tendon in the subluxed position.
     
  15. Scorpio622

    Scorpio622 Active Member

    I always get a DYNAMIC ultrasound before planning surgery. This test is very operator dependent and we are lucky to have a wiz of an ultrasound specialist at our institution. Static MRI is worthless IMHO.
     
  16. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Retromalleolar Groove Impaction for the Treatment of Unstable Peroneal Tendons
    Markus Walther, Robert Morrison, Bernd Mayer
    American Journal of Sports Medicine (in press)
     
  17. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    A New Peroneal Tendon Rerouting Method to Treat Recurrent Dislocation of Peroneal Tendons.
    Wang CC, Wang SJ, Lien SB, Lin LC.
    Am J Sports Med. 2008 Dec 4. [Epub ahead of print]
     
  18. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Intrasheath subluxation of the peroneal tendons. Surgical technique.
    Raikin SM.
    J Bone Joint Surg Am. 2009 Mar 1;91 Suppl 2 Pt 1:146-55.
     
  19. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    A preliminary report on intra-sheath peroneal tendon subluxation: a prospective review of 7 patients with ultrasound verification.
    Thomas JL, Lopez-Ben R, Maddox J.
    J Foot Ankle Surg. 2009 May-Jun;48(3):323-9.
     
  20. NewsBot

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    Articles:
    1
    The Singapore operation for chronic recurrent peroneal tendon subluxation—Short-term follow-up in four patients
    Tim M.S. Millar and Shashi K. Garg
    Foot and Ankle Surgery Volume 15, Issue 3, September 2009, Pages 146-148
     
  21. drsarbes

    drsarbes Well-Known Member

    Subluxed peroneals fall into one of two categories - acute and chronic.
    Depending on the age and activity level of the patient, I have had several acute subluxed peroneals not require repair simply because of the lack of long term symptoms.

    The diagnosis is a clinical one, no studies are needed unless one wants to rule out a linear tear preoperatively.

    Surgical repair is usually just a matter of repairing the ligament, however, I have found that patients with rear foot cavus and/or shallow peroneal grooves at the posterior distal fibula require a bit more if long term results are to be appreciated.

    Deepening of the peroneal groove is a relatively simple matter. A window is removed encompassing the groove, the subcortical bone curretted and the window replaces, thus deepening the groove and at the same time maintaining the rather smooth cortical area.

    The size and health of the small fibrocartilagenous "beak" at the tip of the fibula is also important in maintaining the peroneals in there correct position.

    Good luck

    Steve
     
  22. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Peroneal Subluxation: Surgical Results in 31 Athletic Patients.
    Saxena A, Ewen B.
    J Foot Ankle Surg. 2010 Mar 27. [Epub ahead of print]
     
  23. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Preliminary results of calcaneofibular ligament transfer for recurrent peroneal subluxation in children and adolescents.
    Boykin RE, Ogunseinde B, McFeely ED, Nasreddine A, Kocher MS.
    J Pediatr Orthop. 2010 Dec;30(8):899-903.
     
  24. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Tendoscopic Groove Deepening for Chronic Subluxation of the Peroneal Tendons.
    Vega J, Batista JP, Golanó P, Dalmau A, Viladot R.
    Foot Ankle Int. 2013 Mar 19
     
  25. NewsBot

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    Articles:
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    Articles:
    1
    Peroneal Tendon Displacement Accompanying Intra-Articular Calcaneal Fractures.
    Toussaint RJ, Lin D, Ehrlichman LK, Ellington JK, Strasser N, Kwon JY.
    J Bone Joint Surg Am. 2014 Feb 19;96(4):310-315.
     
  27. NewsBot

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    Articles:
    1
    Peroneal Tendon Dislocation/Subluxation–Case series and review of the literature
    Nikiforos Pandelis Saragas et al
    Foot and Ankle Surgery; Available online 20 June 2015
     
  28. NewsBot

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    Articles:
    1
    Return to sports and clinical outcomes in patients treated for peroneal tendon dislocation: a systematic review.
    van Dijk PA et al
    Knee Surg Sports Traumatol Arthrosc. 2015 Oct 30
     
  29. NewsBot

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    Articles:
    1
    Peroneal tendon dislocation
    N. Espinosa , M. A. Maurer
    European Journal of Trauma and Emergency Surgery; pp 1-7; 12 November 2015
     
  30. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Subluxation of the peroneus long tendon in the cuboid tunnel: is it normal or pathologic? An ultrasound and magnetic resonance imaging study
    Taylor J. Stone , Zehava S. Rosenberg, Zoraida Restrepo Velez, Gina Ciavarra, Roberto Prost, Jenny T. Bencardino
    Skeletal Radiology; p 1-9; 11 December 2015
     
  31. NewsBot

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    Articles:
    1
    Dynamic ultrasound of peroneal tendon instability
    Lionel Pesquer et al
    BJR; in press
     
  32. NewsBot

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    Articles:
    1
    Anatomical Features of Dislocation of the Peroneal Tendon
    -A Case Control Study-

    Masanori Taki, et al
    Foot & Ankle Orthopaedics September 2016 – December 2016 vol. 1 no. 1
     
  33. NewsBot

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    Articles:
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    Incidence of reoperation and wound dehiscence in patients treated for peroneal tendon dislocations: comparison between osteotomy versus soft tissue procedures
    Youichi YasuiKhushdeep S. VigIchiro TonogaiChun Wai HungChristopher D. MurawskiMasato TakaoHirotaka KawanoJohn G. KennedyEmail author
    Knee Surgery, Sports Traumatology, Arthroscopy pp 1–6
     
  34. NewsBot

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    Articles:
    1
  35. NewsBot

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    Articles:
    1
    Calcaneofibular Ligament Transfer for Recurrent Peroneal Tendon Subluxation in Pediatric and Young Adult Patients
    Stenquist, Derek S et al
    Journal of Pediatric Orthopaedics: January 2018 - Volume 38 - Issue 1 - p 44–48
     
  36. NewsBot

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    Articles:
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    Tendoscopic Treatment of Peroneal Intrasheath Subluxation: A New Subgroup With Superior Peroneal Retinaculum Injury
    Matteo Guelfi, MD, Jordi Vega, MD, Francesc Malagelada, MD, ...
    Foot & Ankle International March 29, 2018
     
  37. NewsBot

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    Articles:
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    Treatment of Chronic Subluxation of the Peroneal Tendons Using a Modified Posteromedial Peroneal Tendon Groove Deepening Technique
    Mu Hu, MD, Xiangyang Xu, MD, PhD
    JFAS; Article in Press
     
  38. NewsBot

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    Articles:
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    What Is the Rate of Recurrence of Peroneal Groove Deepening for Subluxation/Dislocation
    Patrick Ward, MD, Robert Anderson, MD, J. Kent Ellington, MD, MS, W. Hodges Davis, MD, Carroll Jones, MD,
    Bruce Cohen, MD
    AOFAS Annual Meeting 2018 1
     
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