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WHAT'S UNUSUAL ABOUT THE TENDONS NOT STAYING IN THE GROOVE AS A RESULT OF AN ANKLE SPRAIN?

Q: I sprained my ankle doing a stupid move on my motorcycle. It never seemed to heal, so I finally went in for help. They discovered the tendons along the outside of my leg aren’t staying in the groove where they are supposed to be. The doc said it was unusual, but I didn’t catch what was unusual and why mine aren’t staying where they are supposed to. Can you help explain this to me?

A: When you sprained your ankle, the injury affected the peroneal tendons, which run along the outside of your leg and behind the ankle bone. Normally, these tendons are held securely in place by a fibrous band called the superior peroneal retinaculum and lie within a groove on the back of the ankle bone (the retromalleolar groove).

What’s unusual in your case is that these tendons are not staying in that groove. This condition is called peroneal tendon instability. It’s a rare but serious complication of a lateral ankle sprain (a sprain affecting the outer side of the ankle). Here’s why this happens and what makes it uncommon:

  1. Ruptured Retinaculum: In a typical ankle sprain, the ligaments around the ankle may stretch or tear, but the peroneal retinaculum usually remains intact. In your case, this fibrous band has likely ruptured, which allows the tendons to slip out of the groove and “dislocate.” This is not a common outcome of most ankle sprains.
  2. Shallow Retromalleolar Groove: Some people naturally have a shallower groove in the ankle bone, which can make them more susceptible to this type of tendon instability, especially after an injury. If the groove is shallow, even a minor sprain can cause the tendons to slip out of place.
  3. Delayed Symptoms: The reason this condition might be missed initially is that swelling from the sprain can mask the symptoms. It’s only after the acute swelling has gone down, and the pain and instability persist, that the underlying problem becomes apparent. Early imaging, like MRIs, might not catch the issue if the tendon is moving in and out of the groove spontaneously. Dynamic ultrasound, which shows the tendons in motion, is usually more effective at diagnosing this problem.

In summary, what’s unusual about your condition is that your peroneal tendons are dislocating due to a combination of the ruptured retinaculum and possibly a naturally shallow groove, making it a rare but significant complication of an ankle sprain. This explains why the pain and dysfunction have persisted, and why surgical intervention might be necessary to stabilize the tendons and restore proper function to your ankle.

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.