What Does the Surgery Involve?

Peroneal tendon dislocation surgery is performed under general or regional anesthesia. The specific procedure depends on the severity of the condition:

1. Retinaculum Repair (Soft Tissue Repair)

• Used when the superior peroneal retinaculum (SPR) is torn or stretched.

• Involves suturing or reinforcing the SPR to hold the tendons in place.

• Often performed in acute injuries where the groove is adequate.

2. Fibular Groove Deepening (Osteoplasty)

• Recommended if the fibular groove is too shallow, predisposing the tendons to dislocation.

• Involves reshaping and deepening the fibular groove to create a more stable track for the tendons.

• Frequently combined with retinaculum repair for additional stability.

3. Tendon Repair or Reconstruction

• Used if the peroneal tendons are torn or severely damaged from repeated dislocations.

• Involves suturing or reconstructing the tendon, sometimes with a tendon graft.

• May include tenodesis, where the peroneus brevis is attached to the peroneus longus for added stability.

After surgery, the foot is immobilised in a cast or boot to protect the repair during early healing.

Alternative Treatments

Non-surgical management may be considered in mild cases or low-demand individuals. This includes:

​

• Immobilisation – A boot or cast to allow healing of the retinaculum in acute cases.

• Physiotherapy – Strengthening exercises to improve ankle stability and proprioception.

• Bracing or Taping – Helps prevent dislocation during high-risk activities.

• Activity Modification – Avoiding movements that trigger instability.

• Anti-inflammatory Medications – To reduce pain and swelling.

However, for recurrent dislocations or high-performance individuals, surgery is typically recommended to prevent long-term instability and tendon damage.

Risks and Complications

Although peroneal tendon dislocation surgery has a high success rate, there are potential risks:

General Surgical Risks:

• Infection – Low risk (<1%), but more common in smokers or diabetics.

• Blood Clots (DVT/PE) – Risk increases with prolonged immobility, requiring blood thinners in high-risk patients.

• Nerve Injury – The sural nerve, running along the lateral ankle, may be affected, leading to numbness or tingling.

• Scar Sensitivity – The incision site may remain tender for several months.

Procedure-Specific Risks:

• Recurrent Dislocation – Rare, but may occur if rehabilitation is not followed properly.

• Tendon Weakness or Stiffness – Some loss of strength may persist postoperatively.

• Delayed Healing – More common in patients with poor circulation, diabetes, or smoking history.

• Ankle Stiffness or Weakness – May require extended physiotherapy.

• Adhesions or Scar Tissue Formation – Can restrict movement and require additional therapy.

Most patients achieve full recovery with improved ankle stability, but full strength return may take up to 9–12 months.

Recovery and Rehabilitation

Time Off Work

• Desk jobs: 2–3 weeks.

• Standing jobs: 6–8 weeks.

• Manual labor: 3–4 months.

Return to Driving

• 6–8 weeks, depending on which foot was operated on and recovery progress.

Return to Activities & Sports

• Walking unaided: 6–8 weeks.

• Running: 3–4 months.

• Full sports participation: 4–6 months.

Rehabilitation Timeline

• Weeks 0–2: Immobilization in a cast or boot, non-weight-bearing.

• Weeks 2–6: Gradual weight-bearing in a boot with physiotherapy exercises.

• Weeks 6–12: Strength, balance, and proprioception training.

• 3–6 months: Progressive return to jogging and low-impact sports.

• 6–12 months: High-impact activities and full return to sports.

Most athletes and active individuals regain full function and stability with structured rehabilitation.