Q: O geez. I sprained the outside part of my left ankle two months ago, and it still hasn’t healed properly. There’s clicking, popping, and pain. I finally saw an orthopedist who said I need surgery because the tendon keeps slipping out of its groove. That sounds scary! Is there any other treatment available?
A: It sounds like you might have a rare type of lateral ankle sprain that involves something called peroneal tendon instability. A lateral ankle sprain occurs when the outer side of the ankle (the side farthest from your other leg) is injured. There are two peroneal tendons that run down the leg and wrap around the back of the ankle bone, sitting inside a groove formed by bone and connective tissue known as the retromalleolar groove. These tendons are held in place by a fibrous band called the superior peroneal retinaculum.
If this fibrous band is torn, the tendons can slip or dislocate out of the groove, leading to ongoing pain along the outer side of the ankle. You may experience the popping or snapping sensation you’ve described, which is a common symptom of this issue.
Non-surgical (conservative) treatment is only effective if the tendons can be stabilized within the retromalleolar groove. Typically, a cast or boot may be used to immobilize the leg, giving the tendon a chance to heal on its own. However, if conservative methods don’t result in the tendon remaining stable or if the dislocation is severe from the beginning, surgery might be the only option.
There are a few surgical procedures to explore. The surgeon may reinforce or reconstruct the fibrous sheath (retinaculum) that holds the tendons in place. Alternatively, the groove can be reshaped or deepened to better secure the tendons. The orthopedist will likely recommend additional imaging, such as an MRI, to assess the damage and decide on the most suitable surgical approach.
If you’re still unsure about undergoing surgery, you might want to get a second opinion. It’s perfectly okay to ask more questions and seek further advice to ensure you’re comfortable with your treatment plan.
Reference: Markus Walther, MD, PhD, et al. Peroneal Tendon Instability: Diagnosis and Authors’ Recommended Treatment. In Current Orthopaedic Practice. March/April 2012. Vol. 23. No. 2. Pp. 80-85.