CHRONIC LATERAL ANKLE PAIN

What Is Chronic Lateral Ankle Pain?

Chronic lateral ankle pain is recurring pain on the outer side of the ankle often develops after an injury such as a sprained ankle. However, several other conditions also may cause chronic ankle pain.

Symptoms

Pain, usually on the outer side of the ankle, may be so intense that you have difficulty walking or participating in sports. In some cases, the pain is a constant, dull ache. Patients may also experience difficulty walking on uneven ground or in high heels, a feeling of giving way (instability), swelling, stiffness, tenderness, or repeated ankle sprains.

Causes

The most common cause for a persistently painful ankle is incomplete healing after an ankle sprain. When you sprain your ankle, the connecting tissue between the bones is stretched or torn. Even with thorough and complete rehabilitation, the ligament or surrounding muscles may remain weak, resulting in recurrent instability. As a result, you may experience additional ankle injuries.

Other causes of chronic ankle pain include: 

• An injury to the nerves that pass through the ankle. The nerves may be stretched, torn, injured by a direct blow, or pinched under pressure (entrapment).
• A torn or inflamed tendon
• Arthritis of the ankle or subtalar joint
• A fracture in one of the bones that make up the ankle joint
• An inflammation of the joint lining (synovium)
• The development of scar tissue in the ankle after a sprain. The scar tissue takes up space in the joint, putting pressure on the ligaments. 
• Severe flatfoot deformity

Prevention

Almost half of all people who sprain their ankle once will experience additional ankle sprains and chronic pain. While most ankle sprains heal, pain lasting 6 months or more after an injury is less common and warrants evaluation by a foot and ankle orthopaedic surgeon.

You can help prevent chronic pain from developing by following these simple steps:

1. Follow your surgeon's instructions carefully and complete the prescribed physical rehabilitation program.
2. Do not return to activity until cleared by your surgeon.
3. When you do return to sports, use an ankle brace until full strength and balance is restored. For some high-risk ankle injury sports, such as volleyball, prophylactic bracing may be beneficial.
4. If you wear high-top shoes, be sure to lace them properly and completely. 
   

Diagnosis

The first step in identifying the cause of chronic ankle pain is taking a history of the condition. Your foot and ankle orthopaedic surgeon may ask you several questions, including: 

• Have you previously injured the ankle? If so, when?
• What kind of treatment did you receive for the injury?
• How long have you had the pain?
• Are there times when the pain worsens or disappears?

Because there are so many potential causes for chronic ankle pain, your doctor may do a number of tests to pinpoint the diagnosis, beginning with a physical examination. Your surgeon will feel for tender areas and look for signs of swelling. They will have you move your foot and ankle to assess range of motion and flexibility. Your surgeon also may test the sensation of the nerves and administer a local anesthetic to help pinpoint the source of the symptoms.

Your surgeon may order several X-ray views of your ankle joint. You also may need to get X-rays of the other ankle so the doctor can compare the injured and non-injured ankles. In some cases, additional tests such as a bone scan, CT scan, or MRI may be needed.

Treatments

Treatment will depend on the final diagnosis and should be personalized to your individual needs. Both non-surgical and surgical treatments may be used. Non-surgical treatments include:

• Anti-inflammatory medications such as aspirin or ibuprofen to reduce swelling
• Physical therapy, including tilt-board exercises, directed at strengthening the muscles, restoring range of motion and increasing your perception of joint position
• An ankle brace or other support
• An injection of a steroid medication
• In the case of a fracture, immobilization to allow the bone to heal

If your condition requires it, or if non-surgical treatment doesn't bring relief, your doctor may recommend surgery. The type of surgery would be determined based on the cause of the continued chronic pain. Many surgical procedures can be done on an outpatient basis. Some procedures use arthroscopic techniques; other require open surgery. Rehabilitation may take 6-10 weeks to ensure proper healing. 

Surgical treatment options include:

• Removing (excising) loose fragments
• Cleaning (debriding) the joint or joint surface
• Repairing or reconstructing the ligaments or transferring tendons

Contributors/Reviewers: David Garras, MD; Robert Leland, MD

The American Orthopaedic Foot & Ankle Society (AOFAS) offers information on this site as an educational service. The content of FootCareMD, including text, images, and graphics, is for informational purposes only. The content is not intended to substitute for professional medical advice, diagnoses or treatments. If you need medical advice, use the "Find a Surgeon" search to locate a foot and ankle orthopaedic surgeon in your area.