The peroneal tendon complex is formed by the tendons of peroneus longus and
peroneus brevis. The primary restraint to tendon subluxation is the superior peroneal retinaculum.
Acute subluxation usually occurs while the foot is dorsiflexed with the peroneal muscles strongly contracted. Acute dislocation of the peroneal tendons is often misdiagnosed as an ankle sprain and treated by early mobilization, which may increase the risk of chronic dislocation. Instability is assessed clinically. A comprehensive examination of the ankle and foot is required to exclude other pathology, such as a lesion of the anterior talofibular ligament. Recurrent or chronic dislocation of the peroneal tendons presents with
instability and clicking of the lateral aspect of the ankle, with the tendons subluxing anteriorly. Although conservative management may be attempted in acute dislocations, recurrent dislocations should be managed surgically. Conservative management of acute subluxation is associated with a high rate of recurrence, and acute peroneal subluxation in high-demand individuals should be primarily managed surgically. Untreated or misdiagnosed acute injury predisposes a patient to pain and recurrent peroneal dislocation. However, recurrent subluxation of the peroneal tendons is uncommon.
The surgical repair includes anatomic reattachment of the retinaculum, , reinforcement of the superior peroneal retinaculum with local tissue transfers, rerouting the tendons behind the calcaneofibular ligament, bone block procedures, and groove-deepening procedures.
Endoscopic anatomical retinacular repair is a more recent technique, which offers an attractive alternative to open repair and may reduce complications and allow early return to sports
Treatment of peroneal tendon dislocation should be based on whether it is an acute or chronic injury and if the patient is or not an athlete.
In case of failure of conservative management or chronic instability, surgical intervention is advised.
Source : “The Peroneal Tendons: A Clinical Guide to Evaluation and Management