Many conditions can cause joint cracking, creaking, clicking, or a general noise that is heard or felt. The causes range from ligament issues, arthritis, and joint instability. However, a somewhat unique condition can develop on the outer side of the ankle that can cause a snapping. There are two tendons that move behind and under the outer bone of the ankle joint. These tendons, one on top of the other, are collectively called the peroneal tendons. There is a long one, and a short one. These tendons help to roll the foot outward, and resist the muscle force on the other side of the foot rolling the foot inward. The tendons move behind the outer bone of the ankle (the fibula), and stay in place behind this bone via a groove in the back of the bone that is covered with a fibrous band of tissue.
Some people are born with an abnormally shallow groove, a weak fibrous band, or an abnormal muscle position causing crowding of the tendon space, and others injure this area later in life causing the band to rupture and pull a small fractured piece of bone with it. Either way, the end result is a snapping or sliding of the peroneal tendons over the side of the ankle bone during certain positions in walking. As these tendons move over the bone abnormally (called subluxation), an audible snapping or cracking sound can be made, and motion can be felt. If one’s ankle is ‘skinny’ enough, the moving tendons can actually be seen.
This sensation is at its least simply annoying. However, in many cases there is actually pain present, and one’s activities can be limited as a result of ankle instability and gradual tendon damage from the abnormal motion against and over the bone. Tendon tears are not uncommon as a result of this abnormal motion.
Treatment of this condition often needs to involve more than just simply supporting the ankle with a brace. Conservative treatment, especially in athletes and active people, does not have a very high success rate. Surgery is often needed to either deepen the bone groove, repair the fibrous band that is supposed to cover the tendons, or a combination of both. Depending on the state of the tendons, some repair may be necessary, and serious cases of tendon degeneration may require tendon reconstruction techniques. This surgery also involves some form of immobilization after surgery, and gradual therapy treatment until full activities can be resumed.
If you have ankles that snap or crack on the outer side, be sure to see your local foot and ankle specialist. Simply assuming this problem is a normal part of the life of your ankle can be a serious mistake, and you may end up with a more serious tendon issue than you started with if the damage is allowed to progress.
Scott R. Kilberg DPM 