Ankle injuries are a frequent cause of patient visits to the emergency room, orthopaedic, and primary care offices. Although lateral ligament sprains are the most common pathology, peroneal tendon subluxations occur with a similar inversion mechanism. Multiple grades of subluxation have been described with a recent addition of intrasheath subluxation. MRI is the best imaging modality to view the peroneal tendons at the retrofibular groove. Currently, point-of-care ultrasound is gaining clinical ground, especially for the dynamic viewing capability to capture an episodic subluxation. While conservative treatment may be attempted for an acute injury, it has a low rate of success for the prevention of recurrent subluxation. Surgical procedures of various techniques have resulted in excellent recovery rates and faster return to play. The aim of this paper is to give a complete review of the current literature on peroneal tendon subluxation and to propose a clinical algorithm to help guide diagnosis and treatment. Our goal is to heighten clinical awareness to improve earlier detection and treatment of this sometimes elusive diagnosis.
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