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Snapping Ankle Physiotherapy



Patients who suffer from recurring/returning ankle sprains may find that their ankle having more "clicking" and "snapping" sounds. This is a condition known as "snapping ankle" (medically termed as slipping peroneal tendon) - basically the peroneal tendon slips in and out of the the groove behind the bone, causing that particular snapping/clicking feeling and sound.

Anatomy of the ankle

So our peroneal muscles comprise of two (2) muscles and they are located outside of the ankle.

They function to help you lift your ankle/feet up to point downwards and outwards (known as eversion). These two muscles go through a groove that's located behind the lateral malleolus (that's the protuding bone at the outside of our ankles) and kept within the same groove by a specific tendon sheath.

There is ligamentous reinforcement (retinaculum) that prevents the tendon from slipping out from the groove, though it may happen due to specific circumstances.

Why do I get this ankle snapping problem?

So when/if we sprain our ankle, especially with the outward ankle roll, that forcefully stretches the peroneal tendon, and this force may cause micro-tears or larger tears in the retinaculum. If the force is great enough, or small micro-tears is frequent enough, it may cause the retinaculum to tear fully.

When this retinaculum is 100% torn, it is unable to hold up the peroneal tendon, which allows the tendon to slip in and out of the groove, causing the clicking, snapping sound in the ankle.

Of course, in some cases and patients, sometimes there are patients who may be born with shallower groove that can cause/contribute to peroneal tendon slippage.

Diagnosis and Management of Snapping Ankles

Peroneal subluxation is unfortunately usually overlooked because it's usually presented with other problems and probable diagnoses such as:

  • acute ankle sprain resulting in acute ankle pain
  • swelling due to ankle sprain
  • etc

To diagnose snapping tendon specificly, it needs to have an experienced sports doctor (physician or orthopedic or foot surgeon) or sports physiotherapist to assess the ankle in different ranges, angles and testing where the tendon would slip out (or not).

The ideal first choice of management for snapping tendon / peroneal subluxation is really to refer to an experienced physiotherapist for ankle physiotherapy. In the earlier stages of physiotherapy, what we do is to:

  • manage and decrease any pain experienced
  • prevent further damage or aggravation of the strain on the retinaculum
  • may create a specific custom-made ankle-foot-orthosis (AFO) if doctor prescibes
  • ultrasound therapy to accelerate soft tissue healing
  • cool therapy to manage/decrease pain and swelling
  • we may use radio-frequency Indiba therapy to accelerate soft tissue healing too

As we progress, we will move on towards:

  • proprioception retraining (to improve local/foot space awareness and correction)
  • strengthening exercises

Unfortunately, at least 1 in 2 (50%) of peroneal subluxation (ankle snapping) happens in active individuals and athletes...and this will result in either surgical intervention, retire from the sport or activity. After surgery, post-op ankle physiotherapy will be required to get your moving and back to sports.

Post-surgical Management of snapping ankles

After your ankle surgery, your surgeon may prescribed immobilization (non-moving) of your ankle for 3 to 8 weeks, and if immobilization is requested, you may be either in a plaster cast or a lighter thermoplastic custom-made ankle foot splint.

Once the immobilization call is lifted, physiotherapy and us will focus on:

As your ankle regains strength, range of motion and with doctor clearance, we will start to focus on:

  • strengthening
  • proprioception retraining (single leg stand, eyes open/closed, wobble board)
  • lower and higher balance training
  • progressing to drills

When you have reached 100% of your ankle strength, stamina and stability and return to sports and life same or better than before then only we will discharge you =)



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