The Most Common Cause of Ankle Cracking, Clicking or Popping: Peroneal Subluxation / Dislocation.
Have you ever heard or felt your ankle “snap” when you walk, or run, or climb some stairs? Did this sound or sensation make you “feel old?” Don’t worry, there are other conditions which can cause this “snapping” in the ankle besides old age and they should be treated by your podiatrist before they become worse.
Although a number of foot conditions may cause a variety of sounds in the joints, such as “cracking,” “creaking,” or “clicking,” or a more general noise that is either heard or felt in the joint, the snapping sound in the ankle is most commonly caused by a tendon slipping over the bone. When this happens, it is common to hear a snapping or clicking sound.
Peroneal Subluxation / Dislocation: The Most Common Cause of Clicking and Snapping Ankles
The outer bone of the ankle joint has two tendons that travel behind it, one stacked upon the other, known as the peroneal tendons. These tendons, one short and one longer, work to stabilize the ankle joint, preventing excessive side-to-side motion of the foot as it “roles” during walking. These tendons sit within a groove in the bone and are kept in place via a band of fibrous tissue called a retinaculum. Should the tendons slip out of this groove, the movement may be felt or the snapping sound may be heard. This condition is known as peroneal tendon subluxation or dislocation. It is usually the peroneus brevis (the shorter of the two tendons) that slips out of place.
The cause of this slippage of the peroneal tendons can vary from patient to patient, but will likely be caused by one of the following:
- Secondary to an ankle sprain
- Congenital shallow groove in the bone
- Weak fibrous tissue band
- Abnormal muscle position (people with unstable feet have more abnormal force on the peroneal tendons)
- Unstable ankles
Whatever the cause of this condition, the patient may hear a snapping sound in the ankle, or may feel the tendons sliding over the side of the ankle bone when walking, running or climbing stairs. At the very least the condition is annoying, yet there may also be pain involved, limiting the patient’s activities. Left untreated, the tendons may become damaged, leading to more severe pain and more difficulty treating the condition effectively.
Treatment of Snapping and Clicking of the Ankle
This condition is almost always treated conservatively and surgery should be considered only as a last resort. Below are some products that we recommend regularly to our patients. They are also affiliate links so we may receive a small commission at no additional cost to you if your order from the link.
Strengthening Program for Peroneal Subluxation / Dislocation and Other Causes of Clicking in the Ankle
We will always include an ankle strengthening program when treating peroneal subluxation. This will usually include a combination of balance exercises and direct strengthening exercises. In some situations we may refer you to a physical therapist to work on the most effective strengthening program.
During the first months of the strengthening program we have our patients wear an ankle brace such as this McDavid Lace-up Ankle Brace with Support Stays. We like this one because it gives excellent lateral support without taking up too much room in the shoe. The brace is important to maintain correct tendon position while the patient goes through a strengthening program.
We have patients wear this during the first 6 – 12 weeks of their exercise program to ensure proper alignment and prevent re-injury. It is important to remove the brace when doing the actual balance exercises but otherwise the brace should be worn all day.
Orthotics and Arch Supports for Peroneal Dislocation / Subluxation
Orthotics are often used to decrease stress on the specific tendon that is causing the snapping and to improve joint alignment. Orthotics act to keep the tendons in better alignment which helps prevent them from slipping out of place. Some patients do well in over-the-counter arch supports and other patients require a custom orthotic to more effectively stabilize the ankle.
Over-the-Counter Arch Supports for Snapping Ankles
If you try an over-the-counter arch support you should get one that is firm and conforms as close to the arch as possible in order to stabilize the ankle and the peroneal tendons as much as possible.
For lace-up shoes we usually recommend the FootChair Orthotic with adjustable arch height. The FootChair Orthotic has a very supportive arch which helps in stabilizing the ankle. It also comes with pads that can be added to increase the arch height for even more support for those who need it.
For women’s flats and heels we recommend the PowerStep SlenderFit. It also has an excellent arch but is designed to fit into women’s heels and flats.
Custom Orthotics for Snapping Ankles
If you find that the prefabricated orthotics help, but don’t eliminate, the snapping of the tendons, then custom orthotics will likely help even more as they will provide greater support and better ankle alignment. If the prefabricated orthotics don’t help at all then it is less likely that any orthotic, including custom orthotics, will help and that the strengthening and other treatments will be more important.
Surgery for Peroneal Subluxation / Dislocation
In rare situations, surgery may be required to resolve the issue. This is especially true of patients with high levels of activity, such as athletes. While every effort will be made to stabilize and support the ankle to improve the condition, and while surgery is always a last resort, it may be required to deepen the groove in the bone or repair the fibrous tissue band, or both. Again, surgery should be considered only as a last resort and every effort will first be made to treat the condition conservatively before resorting to surgery.
Post-surgery therapy will include immobilization and physical therapy before full weight bearing activity may be resumed.
Contact Us Today if you have Snapping Sounds in Your Ankle
If you have begun to experience a snapping sound in the ankle, or pain in your ankles, make an appointment to see us today in our Seattle foot and ankle clinic.
Video: Peroneal Subluxation
Here is a video that we found that provides some good information on peroneal subluxation. The information on the anatomy of the peroneal tendons is excellent. They seem to jump to surgery faster than we would, however. Unless there is pain involved we find conservative care is usually effective.