Peroneal Tendon Subluxation - surgery? Anybody else experience this injury?

Back in mid December I subluxed my left peroneal tendon climbing in the gym of all places. Non-surgical recovery isn't going super hot so I have an appt with a foot/ankle surgeon this coming Tuesday.

Anyone have any expereience with this? I'd love any advice or personal stories you could give me.

Thanks,

Jack

Morning bump

Hi Jack, 

Sorry to hear that. I tore my peroneal tendon last year climbing in the gym. I was in a pistol squat position rocking over on a high foot and slipped off of the hold, felt a sharp pain in my ankle and could not bear weight on that foot. MRI confirmed the tear and I asked to be referred to an orthopedic surgeon 4 months post injury as I was still experiencing ankle instability with certain foot movements. My peroneal tendon was not fully subulxing under examination as it did not snap over the ankle bone but my surgeon offered me a choice of continuing PT, or surgical exploration where he would repair the torn tendon and examine the surrounding area (which was not well resolved in the MRI). I opted to continue PT (this was around Sept of last year and I really wanted to snowboard for the upcoming season). 

Well it turns out that I couldn't snowboard either because I could not control my toe side edge with my injury, so earlier this year I went back to my surgeon and asked for the surgery. It is a ~1hr outpatient procedure and I am currently recovering in a cast. My decision to go ahead with the surgery was based on several factors: 1) no improvement to the original injury after ~8 months. My ankle range of motion is back to normal with PT but there are certain movements that I can't do with my ankle such as crack climbing 2) the surgery has a high success rate and my surgeon has operated on other climbers who went on after recovery to do mountaineering stuff, 3) with surgical exploration my surgeon could visually inspect the superior peroneal retinaculum and surrounding area along with the tendon repair to make sure everything is good. 

If I had a choice I would have gotten the surgery sooner. Here's another more detailed MP thread about peroneal tendon subluxations: https://www.mountainproject.com/forum/topic/107673075/peroneal-tendonitistendon-subluxation

Good luck!

Steven

steven wang wrote:

Hi Jack, 

Sorry to hear that. I tore my peroneal tendon last year climbing in the gym. I was in a pistol squat position rocking over on a high foot and slipped off of the hold, felt a sharp pain in my ankle and could not bear weight on that foot. MRI confirmed the tear and I asked to be referred to an orthopedic surgeon 4 months post injury as I was still experiencing ankle instability with certain foot movements. My peroneal tendon was not fully subulxing under examination as it did not snap over the ankle bone but my surgeon offered me a choice of continuing PT, or surgical exploration where he would repair the torn tendon and examine the surrounding area (which was not well resolved in the MRI). I opted to continue PT (this was around Sept of last year and I really wanted to snowboard for the upcoming season). 

Well it turns out that I couldn't snowboard either because I could not control my toe side edge with my injury, so earlier this year I went back to my surgeon and asked for the surgery. It is a ~1hr outpatient procedure and I am currently recovering in a cast. My decision to go ahead with the surgery was based on several factors: 1) no improvement to the original injury after ~8 months. My ankle range of motion is back to normal with PT but there are certain movements that I can't do with my ankle such as crack climbing 2) the surgery has a high success rate and my surgeon has operated on other climbers who went on after recovery to do mountaineering stuff, 3) with surgical exploration my surgeon could visually inspect the superior peroneal retinaculum and surrounding area along with the tendon repair to make sure everything is good. 

If I had a choice I would have gotten the surgery sooner. Here's another more detailed MP thread about peroneal tendon subluxations: https://www.mountainproject.com/forum/topic/107673075/peroneal-tendonitistendon-subluxation

Good luck!

Steven

Hi Steven,

Thanks so much for your reply! I’m glad to hear you’re recovering well. I have a surgery scheduled for tomorrow, and I’m excited to get healing. I definitely have had a similar experience to you, although over a shorter timeframe. Although it’s been been about 2 months since the injury, I definitely wish I had opted for surgery sooner too. Thanks again for sharing!
Jack

See my other thread on this. I have had bilateral subluxation and surgeries, about 5 years apart, and have lots to say about it. Including a recent re-injury which I have not posted about but further informs my opinions. Feel free to PM me.

Josh Janes wrote:

See my other thread on this. I have had bilateral subluxation and surgeries, about 5 years apart, and have lots to say about it. Including a recent re-injury which I have not posted about but further informs my opinions. Feel free to PM me.

Awesome, thanks. I will.

I did this back in Nov 21. Got the surgery in Feb 22. Could've gotten it sooner but delayed it for a ski trip lmao. I also browsed the linked threads quite a bit during my down time.

For the extent of my injury, I had torn the sheath from the bone, which I think makes it a Grade 2 subluxation. During the few months between injury + surgery, I walked around with a brace and it would occasionally jump the bone, pain got better as time went on (except for the couple times it happened on that ski trip...). When they were repairing the sheath, they found that I had some congenital muscle that crowded the sheath and removed that while also repairing the sheath. I was in a cast for two weeks, then in a boot for another 8 weeks, then PT for 6 weeks. I had started climbing easy stuff with a boot around 6 weeks of the boot, and climbed with it for a couple more weeks once I was walking without the boot, just because I didn't have full confidence in it. My right foot was still noticeably swollen for a couple months afterwards but has returned to a normal size over the new year.

Now that I'm about a full year since surgery, I'd say it was pretty successful. The tendon still feels tighter than the other one, e.g. I can feel it stretching just by flexing my foot in + up, but it hasn't hindered my climbing in any noticeable way. It was noticeably more sore than the rest of my legs after my first time skiing this season, but quickly went away the next day. I think the biggest thing for me was just taking it slow and not rushing back into anything, as badly as I wanted to. It took several months for me to get my confidence back fully once I was out of the boot, but I don't even think about the injury, now.

Good luck! I hope your recovery goes well

Thanks for sharing your experience! I've had the surgery, and I'm excited to start rehabbing. 

Injury:

Peroneal subluxation in left foot. Started as pain running could run it out initially but eventually got so bad I could barely walk. Under diagnosed for 6 YEARS! Finally PT acknowledged the snapping I had told doctors about and recommended me to a well known doctor for my condition. 

Doctor said my fibular groove was essentially non existent. In addition, a tear to the tendon and some fraying and low belly brevis muscle was clogging the works. Therefore, surgery entailed groove deepening, tendon debridement and muscle excision. Oh, I also have high arches so, the doctor did a 1st metatarsal osteotomy to allow the foot to lie more flat reducing pressure on the tendons.

Surgery was TODAY!

I was nervous going in but the crew was swift and confident. They gave me the relaxing agent and I was already out by the time they wheeled me to the surgery room (3 mins).The part I feared a great deal about was the best part. 

Doctor will tell me more tomorrow, but my tendon was still in decent condition that no graft or reattachment was needed but he felt the osteotomy was still necessary. Groove deepening and muscle excision was also still a go.

I’m 12 hours post op and feel incredibly numb. My toes are hot but they said due to the trauma it’s normal (makes sense). I have felt the occasional ache where they did they groove deepening so, game on soon. I’m a nursing momma so want to stay away from all the good stuff that will subside the pain. Hopefully, I can stick with that goal. 

Scooter is fantastic and super fun. A laugh that is needed. 

Fingers crossed this all goes well. My right foot subluxes too so I know it’s most likely next. I would love to run and play basketball again. Most of all, I just want some normalcy just walking and not fear the agonizing pain this has created over the years not to mention the mental wear. Weird thing, some days are pretty darn good where I can move around well and then BAM! Pain for a couple days to weeks. Doctor said that was a normal symptom people had mentioned. Validated.

I will do my best to update you all. I know this is an uncommon procedure but do your research, there are some doctors that know a great deal about it. My doctor seemed completely confident. I’m not sure if I can name doctors on this site. I’d be happy to share his name. However, time will tell more.

Approaching week 6:

Ooof. This has been mentally tough. Keep yourself busy if you can. I’m a teacher so though that is a challenge in itself it helps me feel productive and busy.

I had horrid nerve pain for the first 2-3 weeks. I couldn’t even straighten my leg without getting the cattle prod. Now, it’s just numb and at its max feels like bee stings.
I want to stretch so bad but my foot/ankle won’t allow it yet so I ease into it. I get weird muscle or nerve spasms at night in the Achilles area. Magnesium helps some with that. 

Osteotomy hurts more than I thought it would. I have a weird rash forming hoping I’m not allergic to the metal they put in there. Will find out more soon. Not happy about it, it was a procedure I didn’t really want but trusted the doctor.

My ROM is not even at 50% however, I see slight improvement every day. I can do baby foot circles and dorsiflexion has improved. Calves look like my arms, very sad. My arms, ha, getting pretty strong. I scoot around on them like crazy and hoof myself up.
I do floor and bosu exercises for my core, arms and legs and that has been mentally and physically helpful. Once my nerve pain subsided I was able to do more leg exercises.

TBC….