Snapping Ankle – Why it happens and to get Rid of it

In people who recurrently have ankle sprains, it is not uncommon to hear a clicking coming from the outside of their ankle. This phenomenon is commonly known as “snapping ankle” syndrome or medically known as Peroneal Tendon Subluxation.

As the name suggests for this ankle injury; the clicking sound arises from the peroneal tendon slipping in and out of a groove which is supposed to hold the tendon in place at the outside of the ankle.

Anatomy of the ankle

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 kept within the groove by a sheath.

This complex then re-enforced by a ligament-like structure known as a retinaculum; preventing the tendon from slipping out of the groove.

Why do I have snapping ankle?

With repeated inversion ankle sprains whereby the ankle rolls outward, the peroneal tendons undergoes repetitive tension and stretch to resist this movement of the ankle. This forceful stretch may lead to strain on the retinaculum, which ultimately might cause the retinaculum to tear. This tear in the retinaculum compromises the integrity of the complex; allowing the tendon to slip in and out of the groove leading to the snapping ankle syndrome.

However, it’s important to note that in some cases, there may be a structural cause to the snapping ankle syndrome whereby some people are born with a groove that is more shallow hence increasing the propensity of the peroneal tendon to slip.

Diagnosis and Management of Snapping Ankles

Physiotherapy is usually the first line of treatment for peroneal tendon subluxation which usually accompanies lateral ankle instability. Surgical management for peroneal tendon subluxation/dislocation is usually considered when conservative management of fails whereby there is persistent snapping of the peroneal tendon together with ankle instability despite exercises to improve the stability of the ankle.

Conservative management typically starts with 4-6 weeks of immobilization in a boot to promote healing at the retinaculum, followed by graded strengthening program after that to improve the stability of the ankle to prevent recurrence of snapping ankle.

Post-surgical Management

Should conservative management fail and surgery is required, post surgery rehab to return a client back to pre operative activities is important. The surgery usually has an immobilization period of about 6 weeks in a splint and then in a boot with weight bearing status progressing from non weight bearing to full weight bearing following surgery. During this period, physiotherapy is important for swelling management as well as allowing for early mobilization of the ankle.

Following this 6 weeks period, a client would need to go through 10 more weeks of graded strengthening to return to their activities and prevent recurrence of this issue. Loading needs to be gradual to prevent reinjury to the repaired retinaculum.

Experiencing ankle pain? Click here to find out more about physiotherapy for Ankle Pain Relief and how Core Concepts Physiotherapy Singapore can help resolve ankle pain.