This is happening to me. Anyone else have positive results with treatment? Surgical vs. Non-surgical?

Hi Josh,

My left peroneal tendon subluxates, as a secondary injury from breaking my calcaneus a year ago.

My ortho surgeon said that some people do fine with it for years, others don't, and there is a risk of rupture.

Personally - I'm waiting and seeing, while I'm still in the process of PT and strengthening. I know the surgery is another 8 weeks on crutches, that's just how long soft tissue takes to heal. So I'm putting it off until I *have* to, and I won't know that until I'm a bunch stronger yet. My surgeon is fine with this approach.

I've been climbing so far in my old Kauks, which are the stiffest things out there. Last week I ended up in some regular shoes, and I definitely had a few problems with the peroneal.

As usual, a PT can give you good theraband exercises to strengthen.

Josh and JSH,

I've had problems w/the peroneal tendon for 20 years, due to a fall in Josh. For the last 10 years, I thought the pain was due to a necrotic spot in the Talus bone, but after discovering trigger point therapy this spring have tied it to the peroneal muscles.

Trigger point massage brings immediate relief which can last for hours to days depending how active I am. Trad climbing aggravates the area more than vertical to steep sport climbing.

This spring, I bought a home ultrasound device for a different injury. It seemed to help speed healing greatly over the typical predicted healing time. I used it once so far on the peroneal tendon and muscles and had longer lasting relief than from massage alone.

The Trigger Point Workbook by Claire Davies is a good resource. Ultrasound devices are as cheap as $100 online. Self treatment in combination w/a good practitioner produce the best results in my experience.

So the verdict with mine is pretty typical peroneal tendon "retinaculum" tear. Poor outcome w/o surgery, excellent outcome with surgery. JSH, it sounds like mine is a bit worse than yours, but maybe yours is masked by the more significant problems you've had with your ankle? In my case, unfortunately, there's no "wait and see" - it's a must-operate situ. But it should be a pretty simple fix.

My retinaculum is torn too. I'd guess I've just spent so much time walking weirdly this year, and working on my gait, that I got used to it more than what would happen after a more acute injury. I have an ultrasonic thing at home - might pull it out.

Josh, what did your surgeon say in terms of time on crutches, and in a boot? This is a big deciding factor for me; right now, I just can't stomach the thought of more crutch time (after 6 surgeries this year, wheelchair, walker, etc, etc) so I'm more willing to try to work with what I have right now; I'm sure you know what I mean. And how did you injure yours, was it one incident or a chronic thing, or leftover from your own big fall?

My surgeon did say it's a pretty straightforward fix.

Julie

Julie, this entire past year the attachment point of the retinaculum (lateral malleolus) has been achey, so I think there was some chronic inflammation. This could be due to any number of reasons (my big fall, ACL surgery last year, who knows). But the actual rupture occurred during a routine rock over move on "Forbidden Zone" a few weeks ago.

According to my surgeon, every time my peroneal tendon subluxates, it gets shredded (it's already shredded), and it's only a matter of time before it ruptures which will make things a lot worse. That, and, my tendon subluxates during fairly routine movements (walking or even stretching my ankle) and when it does, it is rather... painful. So, surgery ASAP.

Apparently my particular bone structure (high arches and no groove in the fibula to accommodate the peroneal tendon) makes me pre-disposed to this kind of thing, but during the surgery they'll deepen the groove and at least, according to my surgeon, it should never be a problem for me again (he said I'll be more confident with that ankle than my uninjured ankle). 4-6 weeks recovery time - NWB.

Sorry to hear about your messed-up limbs Julie. My body seemed totally overuse-injury-ache-and-sprain-proof until my big fall... now it seems to be very pissed off at me.

You're reminding me that I really should get it done before I blow the peroneal. Sigh.

Best of luck with yours. Where are you having it done, in NYC? I'm moving to eastern PA in a few weeks, so I'll be looking for a new surgeon if (when) I get mine done.

I have/had peroneal tendon subluxation in both ankles now. I tore the retinaculum on each ankle on seperate occasions. On the first ankle I tore it over 3 years ago, lived with it for 2 years before scheduling surgery, and tore the retinaculum on the other ankle 4 days before surgery. They fixed the new tear and it is 90% better after repair which included a bone block. I still get some minor intrasheath subluxation on the repaired ankle, and it is definitely still tight and lost a bit of ROM. 8 weeks on crutches, 12 weeks before I was walking seminormally, at which point I started climbing with a walking boot on. about 4months before I started toproping without a boot on, and 6 months until I started bouldering on it. Recovery isn't trivial.

As far as the nonoperated ankle, it still pops probably 1-2 times a day on average, and over the years the popping has gotten less painful. There is always still a chance of rupture, and I can't run on it very well but walking/hiking are fine. Can still climb on it but jamming is out. Controlled movement is key. Taping/bracing doesn't work, but is can become manageable. I'm not planning on having surgery on the other ankle any time soon and would rather just deal with the limitations.

Had peroneal tendon subluxation almost three years ago now. I tried for a few weeks to go the non-surgical path but it seemed dismal, not to mention painful as hell. I did the surgery.

I didn't think it would be a big deal, according to the ortho as well. Had my retinaculum repaired and artificially stapled down and a new groove drilled in my bone. 8 weeks on crutches, one in a boot, lots of PT, and I was still able to make a Bugaboos expedition 5-6 months out from surgery. Pain was bad till about 8 months time and mobility terrible. I was always worried it would pop out again, but that was just paranoia.

I'm now climbing as hard as I ever had, no pain in my foot after I was a year out from surgery but I'm positive I'll never have the same mobility/stability as before, and I believe constant attention to peroneal tendon health is pretty important following the surgery.

Good luck, you will be back to "normal", just don't expect it to be an easy road.

Look's like this thread is a few months old, but I wanted to throw out my experience:

I had my peroneal retinaculum ligament torn at the end of April. I was bouldering and doing a standard rocker move putting all my weight onto my right foot and as soon as I rocked the weight my ligament blew (loud pop). I could walk on it right way and it didn't swell too bad, so I just iced and elevated for about 3 days, but I noticed the subluxation feeling and that just didn't feel right. I saw my primary doc who did know what the deal was, 2 weeks later I saw an ortho and he said he was "pessimistic" it would heal on its own, but I tried a light aircast anyway for 3 weeks. No one bothered to do any imaging - that is the first step - get the MRI and figure out what exactly is going on. Didn't get better. Went to another ortho for second opinion (after MRI) and he said I had a 50/50 shot of healing but put me in a metal boot for 6 weeks. Didn't heal.

Finally after months of not being able to do any activity I got the surgery 3 weeks ago. I just had the retinaculum reattached (they put in absorbable bone anchors drilled into the bone and tied the anchors to the ligment). I didn't have to do any groove widening. Surgery was easy and I only had to take ibuprofen after (although they still provide Vicadin if you need it). I woke up in a cast and had the cast cut off 2 weeks later and was put into a metal boot. I started weight-bearing very lightly with crutches after the 2 week mark. I have my first PT appointment today (3 weeks post op).

My advice - get the surgery as soon as you can. I wasted 2 months between not getting the right advice and not sucking it up and doing it when I knew it was the best option. Success rate is well above 90% and they told me, conservatively, I could bike 8 weeks post-op and that I should be back to full strength bouldering 6 months post-op.

Good Luck.

Every time it "pops" the peroneal tendon is moving over your lateral malleolus - maybe it'll be fine, maybe it won't (liken it to a rope under tension dragging across a sharp edge?).

In my case (just a couple dozen pops before I had surgery) and my peroneal tendon was already shredded. They were able to repair it though.

Deepened my (non-existant) groove and reattached the retinaculum. This was last July (I was then non weight bearing for a month). I climbed 5.13 in January, but the real test will be how it does at Indian Creek. Noticeable loss of mobility (inversion) and weakness, but I'm glad I had it done.

Having a podiatrist do this operation sounds crazy to me but who knows.

Jim (and all),

I'd recommend the surgery sooner rather than later. My only regret was not doing the surgery sooner. Josh's analogy of a rope under tension dragging across a sharp edge is a good one. The more damage you do to the peroneal, the longer your rehab will be.

I'd opt for a orthopod over a podiatrist. I saw 3 different docs before choosing mine (My wife is a nurse, so she knew a surgical assistant that had seen each actually perform the surgery, so I ultimately went with his pick). Pre-op prep - watch your diet more than anything - there isn't any strengthening you can do. Since you need the right nutrition to recover and since you won't be as active, just be aware of that in your diet.

Post-op, just do everything they tell you to do. Do the exercises. It sounds simple, but this is where most people can screw it up. Just listen to your PT and spend a lot of time on the bike.

I have some soreness after a heard climbing/bouldering session in the gym, but nothing that hinders my abilities. I'm as confident doing the same moves with the same power as I was before the surgery.

Good Luck!

Best,

Dave