How To Diagnose Lateral Ankle Injuries

By Remy Ardizzone, DPM, and Ronald L. Valmassy, DPM
   Subluxation of the peroneal tendons may occur for anatomical reasons or as a result of an inversion injury but the subluxation is often overshadowed by a lateral collateral ligament injury.35 During an inversion injury and particularly following repeated ankle sprains, the peroneal retinaculum may be stretched and no longer retain the tendons posterior to the lateral malleolus.26,27 If the patient has an anatomically shallow fibular groove, then even a subtle injury to the retinaculum may cause the tendons to slide anteriorly.34,36 Recent studies also suggest that a more posterior anatomic position of the fibula may also contribute to instability, influencing the ability of the peroneal tendons to stabilize the ankle.37    Patients will often complain of sudden sharp pain to the lateral ankle with lateral cutting maneuvers, pivoting or rising onto the balls of the feet.34 Swelling may or may not be present. Often, during the physical exam, the physician can feel the tendons snap or slide anterior to the fibula by palpating the area while the patient either rotates the foot in a circular motion or rises onto the balls of the feet. One may not appreciate subtle sliding of the tendons on examination. Obtaining a MRI can aid in diagnosis since it will show evidence of stretching or scarring of the peroneal retinaculum as well as decreased concavity of the peroneal groove.6,7,26,28-30

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