■ ■ ■ Indications (Who Needs Surgery, When, Why, and Goals)

Patients with acute or chronic peroneal tendon subluxation or dislocation are candidates for surgery to correct the problem. Some patients with acute injury may first try casting for 6 weeks, because this is felt to be successful in curing the problem in up to 50% of patients. Some doctors feel that athletes with this problem, even acutely, should be treated with surgery as soon as is reasonable after the injury due to the uncertain likelihood of success with nonoperative treatment. The goal is to place the tendons back within the groove and perform a procedure to help keep them there and prevent further subluxation or dislocation. This is done either by tightening or reattaching the retinaculum (the ligament-like tissue that covers the groove that the tendons run within) or using other structures to replace or give additional support to the retinaculum covering the groove. Sometimes the groove is shallow and needs to be deepened as well.

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■ ■ ■ Contraindications (Reasons Not To Operate)

• Infection of the ankle

• Inability or unwillingness to complete the postoperative program of keeping off the foot or to perform the rehabilitation necessary

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■ ■ ■ Risks and Complications of Surgery

• Infection

• Bleeding

• Injury to nerves (numbness, weakness, paralysis) of the foot and ankle

• Recurrence of subluxation or dislocation of the peroneal tendon

• Stretching out of the repair

• Continued pain and disability (inability to run, pivot, or rapidly change direction while running)

• Weakness of the muscles of the ankle

• Stiffness of ankle

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■ ■ ■ Technique (What Is Done)

• Different techniques are in use at this time. Currently one of the most popular techniques is to reattach the retinaculum back to the bone of the outer ankle while tightening the retinaculum to remove any slack. Other techniques involve rerouting the tendons, using other tendons or ligaments to replace the torn retinaculum, or using bone to block excess motion by the peroneal tendons. If the groove that the peroneal tendons usually sit in is shallow, many surgeons will also deepen the groove.

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■ ■ ■ Postoperative Course

• Management after surgery varies.

• Keep the wound clean and dry for the first 10 to 14 days after surgery.

• Keep the foot and ankle elevated above heart level as much as possible for the first 1 to 2 weeks after surgery.

• You will be given pain medications by your physician.

• Casting is often used, varying from 4 to 8 weeks.

• Often you are not allowed to bear weight on the leg for between 2 to 6 weeks. This is followed by a short leg walking cast or brace for 3 to 6 weeks.

• Postoperative rehabilitation and exercises are very important to regain motion and then strength.

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■ ■ ■ Return To Sports

• Return to sports depends on the type of sport and the position played, as well as the quality of retinaculum at the time of repair.

• A minimum of 3 months is necessary after surgery before return to sports.

• Full ankle motion and strength are necessary before returning to sports.

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■ ■ ■ Notify Our Office If

• You experience pain, numbness, or coldness in the foot and ankle

• Blue, gray, or dusky color appears in the toenails

• Any of the following occur after surgery:

  • Increased pain, swelling, redness, drainage or bleeding in the surgical area

  • Signs of infection (headache, muscle aches, dizziness, or a general ill feeling with fever)

• New, unexplained symptoms develop (drugs used in treatment may produce side effects)

Do not eat or drink anything before surgery. Solid food makes general anesthesia more hazardous.