Any ideas on peroneal subluxation, I am looking for nonsurgical options. Patient with history of chronic ankle sprains now experiencing subluxation with running. Thanks!
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how do you approach this problem surgically ? -
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bone anchors
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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. -
Related threads:
Pes Cavus w/ Peroneal spasms
Peroneal Tendon Dysfunction -
Thanks Kevin.... I am on the case.
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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. -
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? -
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. -
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Is it always necessarily to diagnose subluxation with MRI or US or is clinical diagnosis sufficient enough?
cheers -
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Retromalleolar Groove Impaction for the Treatment of Unstable Peroneal Tendons
Markus Walther, Robert Morrison, Bernd Mayer
American Journal of Sports Medicine (in press)
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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]
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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.
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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.
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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
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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 -
Peroneal Subluxation: Surgical Results in 31 Athletic Patients.
Saxena A, Ewen B.
J Foot Ankle Surg. 2010 Mar 27. [Epub ahead of print]
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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.
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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
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From Latest Podiatry Today:
How To Manage Peroneal Tendon Subluxation -
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.
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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
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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
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Peroneal tendon dislocation
N. Espinosa , M. A. Maurer
European Journal of Trauma and Emergency Surgery; pp 1-7; 12 November 2015 -
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
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Dynamic ultrasound of peroneal tendon instability
Lionel Pesquer et al
BJR; in press
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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
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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
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From Podiatry Today:
How To Diagnose And Treat Subluxing Peroneal Tendons In The Athlete -
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
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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
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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
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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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Distal Peroneus Longus Dislocation and Pseudohypertrophy of the Peroneal Tubercle: A Systematic Review
Heinz Lohrer et al
JFAS: Article in Press
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Fibular Tip Periostitis: New Radiographic Sign, Predicting Chronic Peroneal Tendon Subluxation/Dislocation in the Setting of Pes Planovalgus
Valentino D. Abball et al
American Journal of Roentgenology: -. 10.2214/AJR.20.23964
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Foot structure is significantly associated to subtalar joint kinetics and mechanical energetics
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Effect of Mass of Running Shoes
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