Acute peroneal tendon dislocations are relative uncommon but frequently unrecognized (or misdiagnosed) injuries that can be source of lateral ankle pain. Considering this, it is probably more common than previously realized. Anatomic abnormalities are the most often associated with peroneal tendon dislocation. Violent sudden reflex contraction of the peroneal muscles is necessary to produce this injury. Diagnosis and treatment are primarily based on the history and physical examination, occasionally by radiographic studies. Classification schemes has little utility for guiding the treatment since the injury pattern cannot be accurately determined preoperatively. Conservative treatment may be considered for acute dislocation but may be associated with high failure rate. Many surgical methods have been described for treatment of this injury, most patients related good-to-excelent clinical results. Most often these injuries occur in a young, athletically active population, surgical reconstruction has a much higher rate of success compared with nonsurgical treatment in this population.