Lateral ankle pain is a pain on the outside of the ankle, which usually develops over time as opposed to an acute ankle injury, such as a sprained ankle which happens suddenly.
Chronic ankle injuries can occur following an acute ankle injury which has failed to heal properly or was not treated correctly in the beginning. The most common causes of gradual onset pain on the outside of the ankle are peroneal tendinopathy (tendinitis) and sinus tarsi syndrome.
On this page:
- Ankle sprain
- Peroneal tendinopathy
- Sinus tarsi syndrome
- Ankle impingement syndrome
- Peroneal tendon dislocation
- Stress fracture of the talus
- Referred pain
- Other injuries not to be missed
The most common ankle injury is a sprained ankle. Sudden pain and swelling are the immediate symptoms. An ankle sprain usually happens when the foot inverts or rolls out, stretching or tearing the ligaments and tendons on the outside of the ankle. Complications of ankle sprains can also cause lateral ankle pain sometime after the injury has occurred.
Read more on ankle sprains.
Peroneal tendonitis (tendinopathy)
Peroneal tendonitis is inflammation of the peroneal tendons which run behind the bony bit on the outside of the ankle (the lateral malleolus) causing swelling on the outer ankle. Tendinopathy is probably a more accurate description of the injury as tendinitis infers an acute ‘inflammation’ of the tendon which is not always the case. Chronic tendon pain is more likely to be from degeneration of the tendon.
Treatment involves applying the PRICE principles of protection, rest, ice, compression, and elevation. Rest is important as this is often an overuse injury. An ankle support brace can be worn to protect the area and keep the tendon warm. Taping can also provide a great deal of support and protection to the ankle. When pain allows a full rehabilitation program of stretching, strengthening and functional exercises should be done.
Read more on Peroneal tendinopathy
Sinus tarsi syndrome
The sinus tarsi is a small bony canal which runs into the ankle under the talus ankle bone. Damage to the sinus tarsi can be caused by overuse or an ankle sprain. Symptoms of Sinus tarsi syndrome typically include pain which may 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 curve on the side of the painful ankle, for example, running around a left-hand bend running track if the left foot would be painful. Inverting the ankle or moving it into a position where it is turned inwards as it would go with an ankle sprain may cause pain with Sinus tarsi syndrome. An anesthetic injection into the painful sinus tarsi will confirm the diagnosis by relieving pain and allowing normal function. An MRI scan may indicate excessive fluid in the sinus tarsi canal.
Treatment involves rest from all painful activities and applying ice or cold therapy to reduce pain and inflammation. A doctor may prescribe NSAID’s or nonsteroidal anti-inflammatory drugs such as ibuprofen (don’t take if you have asthma). Electrotherapy such as ultrasound may help reduce inflammation and swelling caused by sinus tarsi syndrome. Mobilization of the subtalar joint is an important part of treatment and rehabilitation.
Read more on Sinus tarsi syndrome.
Ankle impingement occurs when soft tissues within the ankle get impingement between the bones. It can be anterior affecting the front of the ankle (anteior impingement) or at the back (posterior impingement). Anterior impingement symptoms are felt at the front or side of the ankle. Impingement can often occur following an ankle sprain which fails to heal properly.
The ankle may seem weak and one giveaway sign is reproducing pain by forcing or passively moving the ankle into dorsiflexion or pointing the foot upwards to stretch the muscles at the back of the leg.
Anterior impingement (at the front of the ankle) can occur from a bad or repeated ankle sprain as the ligaments thicken and get pinched between the bones (tibia and talus bone). As the torn or ruptured ligament heals, the body forms too much scar tissue along the front and around the side of the ankle joint creating a meniscoid lesion.
Treatment involves rest for up to 4 weeks. A plaster cast or splint may be fitted to restrict movement of the ankle. Cold therapy or ice can be applied to reduce pain and inflammation. A doctor may prescribe NSAID’s (non-steroidal anti-inflammatory medication). If conservative treatment does not work then surgery may be considered.
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, causing inflammation. Gradual onset pain on the outside of the ankle is the main symptom and is more common among athletes with unstable ankles. Tenderness will be felt where the tendon passes behind the lateral malleolus (bony bit on the outside of the ankle). There may be swelling and bruising over the outside of the ankle and pain when the soles of the feet are pronated or turned outwards and upwards.
Treatment involves applying the PRICE principles of protection, rest, ice, compression, and elevation followed by a gradual rehabilitation program of stretching exercises for the calf muscle and peroneal muscles at the back of the lower leg. Sports massage may also be useful if tight muscles are a contributing cause.
Read more on Peroneal tendon dislocation.
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. 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.
The talus is more susceptible to developing a stress fracture when the ankle is repeatedly overpronated and plantarflexed or rolling in and flattening at the same time as pointing the foot downwards, a movement seen in pole vaulters who plant the pole too late at take off.
Treatment usually involves six weeks immobilization in a plaster cast. Surgery to remove the lateral process of the talus bone is sometimes done which can speed up the healing and rehabilitation process. Identifying the causes of the stress fracture in the first place is important. This can be training errors, poor technique, poor foot biomechanics, or simply doing too much too soon. A full and gradual rehabilitation program to strengthen up the ankle should be done.
Read more on Talar stress fracture.
Do not miss
Injuries which should always be considered when diagnosing pain on the outside of the ankle include: