Lateral ankle pain
Lateral ankle pain is pain which occurs on the outside of the ankle. It can come on gradually over time as a niggle which gets worse, or it can occur after an acute ankle injury which does not heal.
Most common causes of lateral ankle pain
Peroneal tendinitis or peroneal tendinopathy refers to inflammation of the peroneal tendons which run behind the lateral malleolus or the bony bit on the outside of the ankle. Symptoms include pain and swelling on the outside of the ankle, just below the bony bit or malleolus.
Sinus tarsi syndrome - The sinus tarsi is a small bony canal which runs into the ankle under the talus ankle bone. Symptoms of Sinus taris syndrome include pain which may difficult to pin point just in front of the lateral malleolus.
Impingement syndrome is when a bony growth either at the front of the back of the ankle impedes normal ankle movement. Symptoms include pain at the side of the ankle which does not go, possibly after an ankle sprain heals.
Peroneal tendon dislocation is when the peroneal tendon which runs round the back of the bony bit on the outside of the ankle repeatedly dislocates across it causing friction, inflammation and pain.
Stress fracture of the talus - The Talus bone is the bone at the top of the ankle which the tibia or shin bone sits on. Symptoms include a gradual onset of pain on the outside of the ankle.
Referred ankle pain - Pain on the outside of the ankle can also be referred from spine or the peroneal nerve in the lower leg or superior tibiofibula joint which is the joint at the top of the shin where the tibia and fibula bones of the lower leg meet.
Important injuries not to be missed
Stress fracture of the fibula is a small fracture or hairline crack in the bone. It is not as common as a stress fracture of the tibia because the fibula is not used in load bearing in the same way although the constant stress of muscles pulling on the bone through overuse can cause this injury. Symptoms include pain and local tenderness at a point on the fibula as well as pain on weight bearing.
Cuboid syndrome occurs when the peroneus longus muscle in the lower leg applies too much force to the cuboid bone causing it to partially dislocate. Symptoms are similar to that of a sprained ankle and include pain when weight bearing on the outside of the foot
Complex regional pain syndrome
Medial ankle pain
Medial ankle pain refers to pain on the inside of the ankle which is not a sudden acute ankle injury. Pain may come on gradually or from an acute injury that has not healed properly. We explain the most common causes, some less common medial ankle injuries and important conditions that should not be missed.
Tibialis posterior tendinitis (or tendinopathy) - The Posterior Tibialis tendon passes down the back of the leg and under the foot. Injury or degeneration of the tendon may cause pain on the inside of the foot that may radiate along the line of the tendon.
Flexor tendonitis is inflammation of the flexor tendons in the foot which bend the big toes. Symptoms include tenderness along the length of the tendon and pain may be felt in the arch of the foot, on the inside back of the ankle and when the big toe is bent against resistance. The most commonly affected is the flexor hallucis longus tendon.
Medial calcaneal nerve entrapment has similar symptoms to that of tarsal tunnel syndrome where pain will radiate from the inside of the heel out towards the centre of the heel.
Calcaneal stress fracture is a hairline fracture of the calcaneus bone. Symptoms include a gradual onset of pain in the heel. The pain is made worse by weight bearing activities and can be reproduced by a therapist may help diagnose the injury by squeezing the back of the heel from both side which should reproduce the pain.
Tarsal tunnel syndrome is a painful condition of the foot caused by pressure on the Posterior Tibial Nerve. Symptoms include pain which is often described as a burning pain which radiates into the arch of the foot, heel and sometimes the toes.
Talar stress fracture is a stress fracture or hairline crack in the talus bone in the ankle. Symptoms are more commonly a gradual onset of pain on the outside of the ankle rather than the inside which is made worse during running.
Medial maleolar stress fracture is a hairline fracture to the medial malleolus or prominent bony bit on the inside of the ankle. Symptoms include pain and tenderness on the inside of the ankle which becomes worse the more it is used, particularly when running.
Posterior impingement syndrome is when a bony growth at the back of the ankle impinges the normal movement of the ankle causing pain, particularly during movements when the foot is pointed downwards.
Referred pain from the lower back is where pain is felt in the ankle but it is coming from a problem in the lower back via the sciatic nerve. A back specialist, chiropractor or osteopath should be consulted if this is suspected.
Important not to be missed
Navicular stress fracture is one of the more common stress fractures seen in the feet of athletes, especially those involved in sprinting, jumping or hurdling. Symptoms can include a poorly localized mid foot ache that is worse with exercise. It may not show up on an X ray so a bone scan or MRI is usually required.
Complications from acute ankle injuries are injuries or conditions which result from incomplete or poor healing of an acute injury such as an ankle sprain or fracture. It may be something that was missed on the initial diagnosis of an acute injury.
Complex regional pain syndrome
Anterior ankle pain
Anterior ankle pain refers to pain at the front of the ankle. The main causes of pain at the front of the ankle are:
Anterior impingement syndrome is where a bony growth at the front of the ankle impedes the normal movement of the ankle, particularly the talus and tibia bone. Pain is felt during movements where the foot is pointed upwards.
Tibialis anterior tendinitis occurs when the tendon of the large muscle on the outside of the shin becomes inflamed (or the sheath surrounding the tendon). Symptoms include pain when bending the foot and toes up, particularly against resistance. Stretching the tendon may also reproduce pain at the front of the ankle.
Inferior tibiofibula joint injury involves damage to the ligaments that connect the the tibia and fibula at the bottom of the bones.