Lateral Ankle Pain (Outside ankle)

Lateral ankle pain

Lateral ankle pain is a pain on the outside of the ankle. Here we explain the common and not-so-common causes of pain on the outside of the ankle. Acute injuries are sudden onset and include sprains, strains and fractures. Chronic injuries develop gradually over time, often from overuse.


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Acute ankle pain (sudden onset)

Acute ankle injuries include sprains, strains, and fractures.

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Sprained ankle

The most common ankle injury is a sprained ankle. Symptoms consist of:

  • Sudden pain and swelling at the time of injury.
  • Your foot inverts or rolls out, stretching or tearing the ligaments and tendons on the outside of your ankle.
  • Complications of ankle sprains can also occur, causing lateral ankle pain long after your injury occurred.

Chronic ankle pain (gradual onset)

Chronic lateral ankle pain develops gradually over time. It may occur through overuse, or following an acute injury that has not healed properly.

Peroneal tendonitis (tendinopathy)

Peroneal tendonitis/tendinopathy is inflammation of the peroneal tendons which run behind the bony bit on the outside of the ankle (lateral malleolus). Symptoms include:

  • Pain and swelling on the outside of the ankle.
  • In particular, behind and underneath the bony part on the outside, called the lateral malleolus.
  • Symptoms are worse with exercises and improve with rest.
  • Your ankle will feel tender and painful when pressing in along the line the peroneal tendons pass.

Sinus tarsi syndrome

The sinus tarsi is a small bony canal that runs into the ankle under the talus ankle bone. Damage to the sinus tarsi can be caused by overuse or an ankle sprain. Symptoms typically include:

  • Ankle pain that may be difficult to pinpoint but somewhere just in front of the bony bit, or lateral malleolus on the outside of the ankle.
  • Tenderness will be felt at the opening of the sinus tarsi which is located on the outside of the ankle.
  • The patient may have pain or difficulty running on a bend. For example, running around a left-hand bend running track if your left foot is injured.
  • Inverting your ankle or moving it into a position where it is turned inwards may recreate symptoms.

Ankle impingement

Ankle impingement occurs when soft tissues within the ankle get pinched between the bones. It can occur at the front of the ankle (anterior impingement) or at the back (posterior impingement).

  • Symptoms of anterior impingement are sometimes also felt on the outside of the ankle.
  • Impingement may develop following a sprained ankle that fails to heal properly.
  • Your ankle may seem weak.
  • If a partner or therapist passively moves your ankle into dorsiflexion (foot pointing upwards), this is likely to recreate symptoms.

Peroneal tendon dislocation

The peroneal tendon runs behind the lateral malleolus or the bony bit on the outer ankle. Repeated dislocation or slipping can mean the tendon rubs against the bone. Symptoms include:

  • Gradual onset pain on the outside of the ankle.
  • Your ankle will feel tender where it passes behind and under the lateral malleolus (bony bit on the outside of your ankle).
  • You may have swelling or even bruising over the area.

Stress Fracture of the talus

Talar stress fracture

The talus bone is the bone at the top of the ankle which the tibia or shin bone sits on. Stress fractures of the talus are sometimes seen in footballers and track and field athletes. Symptoms include:

  • Pain on the outside of the ankle which will have come on gradually.
  • The pain will get worse with exercise, particularly running, and ease with rest.
  • Bone scans and CT scans can confirm the diagnosis as a stress fracture is unlikely to show up on an X-ray until healing has begun.

Do not miss

Injuries which should always be considered when diagnosing pain on the outside of the ankle include:

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