The peroneal tendons share the retromalleolar groove behind the lateral malleolus, held by the superior peroneal retinaculum. The brevis lies anterior (closer to the bone), the longus posterior. Peroneal tendon subluxation occurs when the superior retinaculum is disrupted, allowing the tendons to displace anteriorly over the lateral malleolus with a palpable snap. The groove position is critical — a shallow or convex groove predisposes to subluxation.
The retromalleolar groove acts as a pulley redirecting peroneal force from the lateral leg to the lateral foot; the superior peroneal retinaculum maintains both tendons within the groove
Acute peroneal tendon subluxation from forced ankle dorsiflexion tears the superior peroneal retinaculum, allowing the tendons to flip anteriorly. Chronic subluxation produces painful snapping. Operative deepening of the retromalleolar groove combined with SPR repair or augmentation is required for chronic or recurrent subluxation.
Superior peroneal retinaculum disruption allowing peroneal tendon displacement over the lateral malleolus managed with groove deepening and retinaculum repair.
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