Peroneal tendon subluxation, should I do surgery?

[DnDiene]

Hi!

I want to start training mma (mixed martial arts) this september. I will take a year off from study and train intensively.

However, a few months ago, I went to my physiotherapis because my ankle sort of snapped all the time. Not painful, but annoying. I didn't hurt my feet or fell or something, one day it just was there. He diagnosed me with peroneal tendon subluxation.

I got conservative treatment for about 10 weeks but that didn't help. Now the only solution seems surgury. However, surgury ofcourse means risks and about 3 months revalidation.
At this moment I can sport without restraint, so I could wait with surgury. However, I don't want to do surgury next year while I'm doing mma, because then I have no study and
when I can't sport or work, I'll have little left to do. If I do surgy now, I can rehabilitate during study/summer vacation.

So, what would you advice me to do? Do you think I can do mma with a non-painful subluxating peroneal tendon?

Thanks!

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[physiobob]

Do both ankles show signs of subluxation? It may be that this was a normal thing for you but that martial arts has made it obvious. I do see this a few times a year in my clinic but I have never referred for surgery unless they becase symptomatic to the point of preventing normal activity for that client. Can you provide us a description the precise movement that you do to make the tendon snap over the ankle joint. This may lead to offering some ideas on the biomechanics of what you may be doing incorrectly.

[Musculoman]

Just supporting physiobob's statement, if it is asymptomatic, surgery is not indicated. You may just as likely have symptoms post surgery due to the nature of surgery itself, leaving you in a worse position!

I would assume an ortho specialist will likely reject surgery in this case anyway. I have seen multiple asymptomatic peroneal subluxations following repeat ankle sprains in basketball players and rugby players who don't seem to be too affected by it in the long term.

[DnDiene]

Thanks for you answers.

Left ankle doesn't snap. For the record I'm currently not doing mma but I will start this summer. At the moment I'm not sporting very much actually

My right ankle snaps when I rotate my foot. I made a video so you can see it (sorry for the crappy quality, I hope you can see the snapping):



Is it possible that the luxation just gets stable, or is it always a downhill ride? From what I hear on the internets it only gets worse over time. Do I have extra risk of tearing/damaging something when I don't do surgury?

I appreciate your answers!

[physiobob]

Looks to me like this is the result of an unstable lateral ligament complex due to a grade three ankle sprain at some stage. If this is so then there is no issue with the tendon. It is behaving as any wood given the laxity on the lateral joint. I would stop playing with it and stop making it happen. If the lateral ankle is truly unstable and is symptomatic then you could consider a lateral ankle stabilizing procedure. That would not address the peroneal tendon as such as with less laxity the tendon should stop subluxing.

Of course all this is just theory as I am discussing this on a forum and have not seen the ankle in the clinic.