UNCORRECTED PROOF Management of Recurrent Subluxation of the Peroneal Tendons Nicholas Antonio Ferran, MBBS, MRCSEd a , Nicola Maffulli, MD, PhD, FRCS(Orth) a, * , Francesco Oliva, MD b ½Q1 a Department of Trauma and Orthopaedic Surgery, Keele University School of Medicine, Hartshill, Thornburrow Drive, Stoke-on-Trent, Staffordshire, United Kingdom ST4 7QB b University of Rome ‘‘Tor Vergata,’’ Faculty of Medicine and Surgery, Department of Orthopaedics and Traumatology, Viale Oxford 81, 00133 Rome, Italy Subluxation of the peroneal tendons is an uncommon sports injury [1], first described in a ballet dancer by Monteggia in 1803 [2]. It is often asso- ciated with skiing [1], ice skating, soccer, basketball, rugby, and gymnastics [3]. Acute subluxation usually occurs during forced dorsiflexion of the foot, causing the peroneal muscles to strongly contract [4]. In acute peroneal subluxation, conservative management is associated with a high rate of recurrence, and high-demand individuals should probably be primarily managed surgically [5]. Untreated or misdiagnosed acute injuries predispose patients to recurrent peroneal dislocation [6]. Anatomy The lateral compartment of the leg contains the peroneal muscles. Pero- neus longus originates from the head and upper two-thirds of the peroneal surface of the fibula and from the intermuscular septa. Peroneus brevis orig- inates from the lower two-thirds of the fibula. In the middle third of the fib- ula, its origin lies in front of that of the peroneus longus, and the two muscles and their tendons maintain this relationship. The broad tendon of peroneus brevis lies immediately posterior to the lateral malleolus. The nar- rower tendon of peroneus longus lies on that of peroneus brevis. The pero- neus brevis tendon passes above the peroneal trochlea of the calcaneus to insert into the tubercle at the base of the fifth metatarsal. The tendon of * Corresponding author. ½Q2 E-mail address: n.maffulli@keele.ac.uk (N. Maffulli). 1083-7515/06/$ - see front matter Ó 2006 Elsevier Inc. All rights reserved. doi:10.1016/j.fcl.2006.06.002 foot.theclinics.com ARTICLE IN PRESS 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 fcl0326  29 June 2006  9:11 pm Foot Ankle Clin N Am j (2006) j–j