Therapy of peroneal tendon dislocation

In recent years, expert opinion is increasingly moving towards the surgical treatment of peroneal tendon luxation. Nevertheless, the treatment can be conservative if there are reasons against surgery or if a better result is hoped for. Conservative treatment is only indicated if the dislocation of the peroneal tendon is caused by an accident, such as during sports or after twisting the foot.

If it is a congenital problem that leads to peroneal tendon dislocation, surgical treatment should be considered. Conservative treatment consists mainly of immobilisation of the affected ankle joint and special exercises as part of physiotherapy. In the case of acute peroneal tendon dislocation, immobilization is achieved by means of a special bandage or cast, which must be worn for 4-6 weeks.

During this time, the foot involved must not be put under any strain. However, this type of treatment of a peroneal tendon dislocation leads to healing in only about 50% of cases. Parallel to this, the treatment is carried out conservatively by treating symptoms such as pain and swelling with pain and anti-inflammatory drugs (ASS, Ibuprofen, Diclofenac).

After removal of the plaster cast, a gradual approach to full load capacity follows, with physiotherapy playing a decisive role after a peroneal tendon dislocation.After the acute treatment of peroneal tendon dislocation comes the phase in which the atrophied muscles involved are rebuilt. This takes place within the framework of physiotherapy. During physiotherapy, certain exercises are shown and performed under professional guidance, which strengthen the muscles and tendons of the leg and foot.

It is usual to regain enough stability in about 2-3 appointments per week over a period of 2-3 months. It is important in physiotherapy that the patient takes the tasks seriously and conscientiously carries out his training program exactly as instructed. Otherwise, a renewed dislocation of the peroneal tendon can quickly occur.

According to current opinion, surgery should be the treatment of choice for acute peroneal tendon dislocation after an accident, as well as for dislocation of the peroneal tendon due to a disposition. Surgery is also indicated if the treatment was not successful conservatively. There are three different approaches: Firstly, the peronaeal tendons can be reconstructed with the help of tendons taken from elsewhere and thus returned to their anatomical location.

However, this surgery requires a 4 to 8 week rest period in a plaster cast. There is also the method of transfer surgery after peroneal tendon luxation, in which the luxated tendons are placed under a ligament (ligamentum calcaneofibulare) existing at the ankle and fixed there. Here too, a break of several weeks is required.

The third option is a procedure in which the groove in the bone where the peroneal tendons are located is deepened and the tendons are covered with a small, bony piece. In this deep bone groove, the tendons can glide more stable and without dislocation. The advantage here is that, depending on the pain, full weight can be applied directly. Which operation is used always depends on the type of peroneal tendon dislocation and the extent of the pain. Therefore, a decision should always be made in each individual case by doctors experienced in this field.