The most common causes of pain over the lateral ankle are chronic ankle sprains that lead to chronic spraining of the anterior talofibular ligament, peroneal tendon pathology including tearing or subluxation, and anterior lateral ankle impingement syndrome. We also sometimes see pain from chronic small avulsion fractures from a previous ankle sprain off the fibula and pain from the subtalar joint over the lateral sinus tarsi also causes pain very close to the same area.
When patients have chronically had inversion ankle sprains, they can end up with chronic sprain to the anterior talofibular ligament which causes pain and instability over the lateral ankle and makes them more prone to have recurrent inversion ankle sprains. In earlier stages this can be addressed with physical therapy and bracing. If this has been happening for years and continues to give patients problems, there is a surgical repair called a Broström lateral ankle stabilization that we use to repair these ligaments and stabilize the ankle.
The next most common cause of pain in this area is from tearing of the peroneal tendons or subluxation of the tendons. There are 2 tendons on the outside of the ankle that help to evert the foot called the peroneal tendons. These tendons are prone to get tearing in them with any trauma and chronic tearing of the tendon can cause pain at this site. Sometimes, if the peroneal retinaculum is torn, the tendons can also sublux or pop out of place from where they are supposed to sit at the posterior aspect of the fibula and this can also cause pain. When patients have peroneal tendon tears that do not respond to conservative measures, we can surgically repair the torn tendon to help with the pain. If the tendons are subluxing, there are several different procedures to repair the retinaculum to hold them in place and also deepen the groove in the fibula to help the peroneal tendons have an appropriate place to stay and glide without subluxation.
Anterior lateral ankle impingement syndrome occurs when the anterior inferior tibiofibular ligament hypertrophies and pinches and the ankle joint. We will hear patients say that the anterior lateral ankle really hurts if they sit for a long time with the foot dorsiflexed because of the tissue pinching in this area. This can bother people especially on longer plane flights or sitting at a desk for a long period of time. This can be addressed more minimally invasively with arthroscopy to remove the impingement and can typically help with the pain if conservative measures do not relieve the pain adequately.
When patients have had chronic ankle sprains, sometimes they also have avulsion fractures off of the fibula in this area that can cause pain. Often times if we need to perform a Broström lateral ankle stabilization to stabilize the ankle, these bone fragments are removed at the same time as the other procedure to help alleviate the pain.
The last reason we see people with lateral ankle pain actually comes from the subtalar joint. The subtalar joint is the joint that sits below the ankle but it is close enough to the ankle that it is hard to determine whether or not the pain is coming from the ankle joint or the subtalar joint sometimes. Patients with flat feet are more prone to have subtalar joint impingement which we call sinus tarsi syndrome. Custom orthotics and steroid type injections can be used to help alleviate the symptoms and if the subtalar joint becomes arthritic and this is a chronic problem, we also will perform a subtalar joint fusion or arthrodesis to try to alleviate this pain more long-term.
If you are suffering from any acute or chronic foot and ankle pain, call your expert Colorado Springs foot and ankle surgeons and podiatrists at 719-488-4664. The whole team at Foot and Ankle Institute of Colorado is here to serve you and your family and friends with all of their foot and ankle needs.