I have been in contact with a man named Brian who went through the surgery and recovery process about 10 years ago. There was very little information available about subluxing peroneal tendons at the time, and Brian had a very rough recovery. Here is his story:
I had this surgery performed on me 10 years ago.
I sprained my ankle in February 2001 and it just never seemed to heal. I was, and still am to this day, an athletic person (to give you an indication of my general fitness and level of activity at the time of injury and recovery). I was 28 at the time.
I sprained it while hiking. I slipped on a rock, fell on my butt first, and both my feet hit the ground hard simultaneously second. The sprain was caused by hitting another angled rock (don't recall the direction of the angle). It wasn't a classic inversion injury. I heard a very loud pop and felt immediate and intense pain which subsided after about 10 seconds or so. Massive swelling afterwards, but that's probably because I had to walk about two miles down the side of a mountain in Gatlinburg to get to my car and then drive 30 minutes to the ER spot before being able to ice it and prop. Despite the injury, while going down that mountain trail, I could still walk with some pain and the ankle felt stable.
Months had passed and I still had a lot of pain and swelling, more toward end of day and definitely linked to activity (even if just walking). Some days were better than others, but I knew something was wrong. The pain could best be described as a "constant dull and rather vague throb" which started out in the morning light but consistently intensified after using it in any way.
Later on during rehab, I knew my ankle "clicked," or "snapped" when I made certain motions, and I could sometimes even feel something like a chord moving in my actual leg occasionally while walking. You could see the tendon moving around the ankle bone region when it would happen if you inspected it directly.
After awhile, I figured out how to "make it happen" when I put my ankle in certain positions (can't remember now how I did it, but could do it at will back then). It didn't hurt when I forced it to sublux, so I didn't think too much of it other than to think that "in time, that strange noise and feeling too will pass."
At first, I saw a general surgeon and went through extensive PT (was finally discharged because my ankle was so strong and stable). But I still had the pain and swelling and it was rather debilitating despite "my overall good ankle health". In addition the spot over the superior peroneal retinaculum was always tender to the touch. Not badly painful, just tender to the touch in that specific spot. Mentally, I made it through every day living but was a nervous wreck. I graduated from school, started my first professional job, got married, etc.
On my PT's advice, I went to an orthopedic foot and ankle surgeon highly acclaimed in my area. At first, he had me wait some more time. He told me that ankle sprains can hurt and swell for a long time, more time than people might think. Then, after more time passed (maybe a month), he suspected a longitutudal tear of the peroneus brevis. After an MRI (which didn't show anything), a steroid injection to help confirm his clinical diagnosis (which helped), and some more passing time the doctor agreed to perform exploratory surgery. He opened me up in October that year and found that my superior peroneal retinaculum was fully torn. Everything else in my ankle was fine. He did a bone block version of the surgery (he basically took a piece of bone out, placed my tendons underneath, and screwed the bone back in place). He told my dad that he did this because repairing the actual retinaculum had a high failure rate and this technique was very successful for him. He also indicated that he did the same surgical procedure on a professional athlete the prior week.
After the surgery, it did take a long time for it to get back to normal. For me, nearly a year and a half. Unfortunately, I had some wound healing issues. My surgical incision opened and it had to heal by secondary means (i.e. it had to heal by scarring). My mom, a nurse, packed my wound every day for a month and kept it sterile. It healed and I was fortunate, with antibiotics, to not have suffered any infection.
The first six months involved more pain and more swelling (my doctor prescribed a compression stocking which helped).
I had pain around my surgical scar for a long time (which rubbed against my shoes driving me crazy). I complained about it a fair amount back then to my doctor as I recall, and he offered with some hesitation to open me back up (after much begging on my part) to remove the screw, which he suspected was the source of my pain.
In the end, I heeded his advice and didn't do a second surgery. He told me he could do it anytime and that the longer I wait the more likely the body will heal it on its own. Apparently the human body is an amazing "machine" that is very capable of correcting itself, it just sometimes takes a lot of time.
Following his advice, I just "accepted the pain," knowing I could have the surgery on my terms if needed it, and moved on with my life.
In March of 2004, three years later, I was basically better. I started doing heavy dead lifts and squats again, running seven and eight miles at a stretch, etc. I looked down one day (remember, at this point, I had "accepted my condition" and didn't dwell on it anymore), and noticed no swelling and no pain. This was after a ten mile run. At that point, I knew I had healed.
So here is my advice to you reading this right now and doubtless suffering like I did: Chin up. If you have this condition and need the surgery, get it. It will not heal on its own because the subluxation won't allow it and the retinaculum gets little if any blood in the best of circumstances. It seems to me that if it's still intact and just stretched, then you may be able to avoid the surgery given some immobilization and a lot of time, but otherwise you pretty much need it.
It's a long road, but in the end after everything I went through, was totally worth it. The success rate (at least for the bone block version) is very high (I mean, seriously, if its wedged between bone it cannot move out of place anymore).
This condition is not like cancer or a disease to where if you don't fix it you will suffer mortality. But if you are even the slightest bit athletic, or just hate that constant pain and swelling, then do it. Find a good foot and ankle specialist, the best in your area. Ask around. Find out who treats the professional sports teams, ballerinas, etc. in your area and book an appointment with them, even if you have to wait a month to see them.
It's a rare condition and general orthopedic doctors just don't seem to know much about it; but the specialists see it all.
It's worth every second of the recovery to get your life back, regardless of the time it takes to finally mend.
Thank you for sharing this with us Brian! I will post a follow up from him soon! If you have a story about your experience with an ankle injury, email me at emmagreenie@live.com and if I get your permission, I will post it to this blog!
