Snapping Ankle

In people who recurrently sprain their ankle, it is not uncommon to hear clicking coming from the outside of their ankle. This phenomenon is commonly known as “snapping” ankle or slipping peroneal tendon. As the name suggests, the clicking sound arises from the peroneal tendons slipping in and out of the groove behind the bone sticking out on the outside of the ankle. Medically, it’s known as peroneal subluxation.

Anatomy

The peroneal muscles are made of 2 muscles and lie on the outside of the ankle. They assist in pointing the foot downwards and outwards. These two muscles run through a groove behind the lateral malleolus and are kept within the groove by a sheath. This complex is then re-enforced by a ligament-like structure known as a rectinaculum, preventing the tendon from slipping out of the groove.

Why do I get this problem?


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When you roll your ankle outwards, it may put the peroneal tendons on a forceful stretch. This forceful stretch may cause tears in the rectinaculum. Frequent sprains would thus increase the strain on the rectinaculum, which ultimately might cause the rectinaculum to tear. This tear in the rectinaculum compromises the integrity of complex, allowing the tendon to slip in and out of groove.

However, in some cases, there is a structural defect that causes the slipping. There are some people born with a shallow groove and thus gives rise to the slipping

Diagnosis and Management

Diagnosing a peroneal subluxation is normally overlooked as this problem is commonly superseded with other more acute pain of an ankle sprain, like swelling arising from an ATFL strain. Diagnosing this problem requires a close examination of the ankle. An experienced Sports Physician, Orthopedic Surgeon or Sports Physiotherapist would normally assess the ankle in all ranges to check whether the tendon would slip out. Another common test would be a resisted up pointing and out turning of the ankle. This could cause the tendon to thicken and slip out of the groove and can be felt at the back of the lateral malleolus. Pain, tenderness and swelling may also be seen over the tendon behind the rectinaculum.

The first choice of management for a peroneal subluxation is a referral to physiotherapy for rehabilitation. In acute stages, the aim is to prevent further aggravation to the strain on the rectinaculum and a cast might be used for the first 4-6 weeks. During that period, gentle stretching of the tendon and range of movement is advised to prevent stiffening of the ankle. Ultrasound and cryotherapy may also be used to help manage the pain and swelling if present. Following the protective phase, proprioceptive training and eccentric strengthening exercises of the peroneal tendons are essential in prevention of a recurrence.

However, 50% of acute subluxation tends to recur in active athletes. This would normally result in either surgery or a retirement from the sport. There are 3 common surgical techniques:

  1. Rectinaculum Repair
  2. Groove Reconstruction
  3. Construction of a bony block

Following surgery, physiotherapy will be essential to get you back to sport.

Post-surgical Management

An immobilization period varying from 3-6 weeks will follow after surgery. Upon removal of the cast, achieving a full range of movement of your ankle will be the main goal of rehabilitation in the first 4 weeks. Pain controlling modalities like ultrasound and TENS may be used if pain is present. Building up the strength and proprioception of the ankle with exercises like calf raises and single leg stand (eyes open/ eyes closed) would normally start about the same time. Progressing proprioceptive training from standing on stable ground to a rocker board, followed by a wobble board is a normal progression before proceeding to agility drills. Only when one achieves full range of movement, good strength and ability to complete sports specific agility drills will one be allowed to return to sports.

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Comments

  • Emmy1985

    i have this problem my leg gets painful so i have to click my ankle so the pain goes away is that normal?

  • http://www.sprainedankle.org/ Sprained Ankle

    @Emmy – Unfortunately, that sounds like a “normal” part of this condition. Have you been in to see a doctor at all? He or she can help you diagnose and decide on the right form of treatment for you.

  • Brian

    For me, the sound and the pain are minor irritants.  I can still run and play basketball sufficiently.  So, my question is, what is the harm I may incur by ignoring this problem?  Get worse, stay the same, or improve?  If get worse, how worse?

    Thanks,
    Brian

  • Anonymous

    I Have ‘snapping Ankle’ i have had this since i can remember (being 26 now), i struggle to go on brisk walks and running is not an option as my ankle gives way and i can no longer walk on it.
    I have been to the doctors for many years and have had no help’growing pains’, ‘Its just the tendors doing something’ never really had the chance to find out what that something was.
    Recently been back yet again as the snapping is getting to the point where just wlaking its a issue you hear it over general out door noise the snapping is so loud and painful.  Doctor refered me to a have an X RAY which came back ‘clear’ so i refered my self to a sport injury Thearpy who refered me to Ostropath, i dont 9 hous treatment and still no different.  I have now stopped going as i cannot afford to spend £35 per half hour session to try ease the pain that it was doing at the time the snapping didnt stop but the pain eased.
    After reading the above article i now have a more open view and now will be returning to the doctor with a printed version to get this sorted.
    I will keep you posted!

  • Cis

     Yes. I reckon you have tightness in your lower body, probably in the back of your body. Try massaging the soles of your feet, do more calf and hamstring stretches to start with.

  • Simonverhamme

    I’ve had it for a year now. I play volleyball so after an hour or two, every time I jumped, my ankle snapped. Not that it was painful, it just felt ‘wrong’. After three minutes and some soft rotations of my ankle, that feeling was gone. The problem was that my confidence (in vertical leap) wasn’t normal anymore, so playing at a good level was not an option… A general practicioner, a physiotherapist and  a sports doctor later I still hadn’t figured out what was going on. But then some secretary of the second sports doctor came along…she immediately knew what was wrong.
    Anyone got a surgery for it already? and what were the results?

  • Runner

     Perhaps use a good ankle support (like an Aircast A60) when you exercise, or for walking if you want confidence? This gives good support, and prevents that awful feeling when your ankle ‘rolls’- which mines does quite frequently

  • waitingfortheothershoetodrop

    My left ankle started out with this issue then the tendon tore and had to be repaired surgically. The post op rehab was crutches for about a month, then a boot for weeks after that. The PT lasted for what seemed to be forever–because I had A LOT of adema for about a year. That whole episode is a year behind me and the ankle is excellent…but now my right ankle is very sore and clicking….but at least it’s not torn.

  • http://www.facebook.com/tiffaney.plamondon Tiffaney Plamondon

    I think this is what i have, it snaps and clicks when rolling my foot, but then it gets to the point where sometimes Im running around, and it clicks once, and leaves me imobile because it hurts so bad, and I have to force my self to move the foot so it clicks again. Is this what the Snapping Ankle thing is? or is it something else?

  • HELP

    Help me please my ankle is sore when i stand on it and when i roll it around it clicks what does this mean?? please reply as I’ve got a tennis tournament tomorrow and i dont want to miss it. Do you think i could play tennis tomorrow?

  • ?

    My ankle does this, and it’s been doing it for a little over a year. It started happening when I went skiing. Also my ankles are hyperactive. Would that have anything to o with it?

  • red

    My ankle i tore my ligaments 9 years ago now any time i move my ankle it snaps and i have pain go up my leg and sometimes my ankle just gives out it snaps so loud u can here it threw my work boot i don’t know what to do

  • Kody

    I ignored this problem for years because I thought it was nothing. It was my worse mistake ever. After I run for a little it swells and the pain is so bad I can barely limp. I can take a lot of pain, I play football and I box on the side and I aspire to become a United States Marine one day. Though this will likely keep me from it. So if you are in the early stages, get it checked out and fixed as soon as possible before it could ruin your life.

  • Kody

    It will get pretty bad. I ignored this problem for years because I thought it was nothing. It was my worse mistake ever. After I run for a little it swells and the pain is so bad I can barely limp. I can take a lot of pain, I play football and I box on the side and I aspire to become a United States Marine one day. Though this will likely keep me from it. So if you are in the early stages, get it checked out and fixed as soon as possible before it could ruin your life.