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Ankle Swelling

Fibular tendon lesions can be caused by several factors and are usually associated with tendon dislocations or subluxations (swelling in the ankle).

Understanding the cause of the injury is imperative in providing the appropriate treatment. Injuries, physical predispositions, and a patient’s medical history need to be taken into account.

Find out more about fibular tendon dislocations below.

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Stress

Stress on the joints and lower limbs may be caused by prior injuries that altered the way you walk. This can result in joint pathologies.

The fibular tendons originate in the lateral part of the leg, following the lateral malleolus to fixate in the metatarsals. Thus, stress or trauma to one part can cause lasting effects on the leg and ankles.

The function of fibular tendons

Dislocations and subluxations in the fibular tendons can seriously affect your movements by causing swelling in the ankles. Since fibular tendons are primarily responsible for the eversion movements of the foot, injuring them can affect your mobility.

The fibular tendons also function as dynamic stabilizers, protecting the foot from potential ankle sprains. In such situations, clinical diagnoses usually focus on lateral ligament injuries and the fibular tendons are often neglected.

How fibular tendon subluxation occurs

Ruptures of the upper retinaculum are usually the cause of fibular tendon dislocations, resulting in swelling of the ankle. In other circumstances, the upper retinaculum pushes the periosteum away from the lateral malleolus, causing laxity in the retinaculum.

There is an apparent relationship between the shape or size of the fibular groove and the level of instability of the fibular tendons. The fracture due to avulsion of the lateral sulcus of the distal fibula also occurs with dislocation, or subluxation of the fibular tendons.

Any Occurrence

Anything that leads to a sudden and strong contraction of the fibular muscles can cause subluxation of the fibular tendons. This is the case if it’s linked to the dorsal flexion and eversion of the foot.

In this way, the tendons are forced anterolaterally so that there is a rupture of the retinaculum. Thus, the avulsion fracture of the lateral malleolus and swelling in the ankle are a result. When this occurs, the patient usually hears and feels a crack or snapping sensation around the ankle bone.

What is the difference between subluxation and sprains?

Sprains (or “ligament distension”) and subluxation of the fibularis can be differentiated.

Subluxation of the fibular tendon presents edema (swelling in the ankle), retromalleolar ecchymosis, and pain in the topography of the tendon.

In subluxation, when eversing the foot, it is possible to observe the subluxation of the fibular tendons—especially if the acute symptoms have subsided. At this point, patients usually complain about a cracking sensation.

Retinaculum Reduction

The reduction of the superior fibular retinaculum can be caused by chronic lateral instability of the ankle. This, in turn, leads to the instability of the fibular tendons (with frequent displacements and subluxations). Hence, the friction of the malleolar portion of the fibula with the short fibularis is caused, breaking the tendon longitudinally and causing consequent swelling in the ankle.

Critical Areas for Subluxation

Among the areas in which subluxation can occur, the distal end of the malleolar groove is at the greatest risk. This is because the fibular tendons at the distal end are the ones that suffer first with the three-dimensional movements of the foot at the subtalar joints of the ankle.

Foot in Contact With the Ground

When the foot is in contact with the ground, and the fibular muscles are struggling with a fixed insertion and mobile origin, there is a greater chance of damage. When the foot is in this position, both the eccentric and the concentric contractions of the muscles create forces that act on the superior fibular retinaculum.

Surgical Treatment

Often cases of traumatic dislocations of the fibular tendons end up being neglected due to the complexity of their diagnoses. This condition is commonly confused with cases of ankle sprains.

When the surgical procedure is performed, the surgeon seeks to understand the condition of the tendon when analyzing whether there has been a loss of pearly color, while also looking for cracks and fraying.

Through a curved line incision of about 10 cm, the access route is made during the procedure. Since this occurrence is relatively rare and the acute symptoms can cause pain and impact your quality of life, effective surgical treatment is imperative.

Retinaculum Ligament

The ligament of the superior fibular retinaculum is severed, leaving the tendons exposed. If there is a dislocation, the parietal edges will be altered.

The surgical procedure relies on a cut fibular crest, osteophytes (to be flattened), presence of accessory muscle, or low-implanted muscular belly. The treatment may require debridement (cleaning of tissue residue) with sutures, or proximal and distal solidarity. The selection depends on the size of the compromised area. At the end of the procedure, the Superior Fibular Retinaculum is sutured in a “jacket” for protection.

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