A Patients Outside Ankle Pain Due To Loose Ligaments
We often see patients with outside ankle pain who have no idea how it happened they just know their ankle suddenly started hurting. One patient was a classic example of this. As an athletic hockey and Lacrosse player, however, its highly possible he experienced sprains and other ankle injuries, even minor ones, over the years, and these, rather than one big traumatic episode, could have been the catalyst to his sudden outside ankle pain.
Dr. Centeno used stress ultrasound imaging to examine this patients ankle . The stress ultrasound revealed that it was indeed this patients ligaments that were causing his outside ankle pain. In fact, he had five damaged ligaments! Not only were they loose they also had many partial tears. The ligament damage had, over time, created instability between the two lower-leg bonesthe fibula and tibiadue to the ankle joint lacking control and stability and, in short, just moving way too much. This, of course, stressed all the ankle structures, creating abnormal motion, and causing outside ankle pain.
If this patient had gone to the average family doctor, podiatrist, or even an orthopedic surgeon, this diagnosis would more than likely have been missed as an MRI would have been the standard diagnostic tool for his ankle pain, not a stress ultrasound, and as we mentioned above, an MRI would not have found these issues.
Common Causes Of Ankle Pain
If you are experiencing ankle pain, there is a good chance it may be due to one of these common causes.
An ankle sprain is an injury of one or more ligaments . Ankle sprains may happen from stepping off a curb, walking on an uneven surface, falling, or playing a sport like tennis or basketball where a rapid change in direction causes the ankle to roll or twist inward.
Most commonly, ankle sprains happen in the anterior talofibular ligament , which is on the outside of the ankle. Symptoms include throbbing pain on the outside of the ankle, along with swelling, bruising, and/or a feeling that the joint may give out.
Medial sprains, involving the ligaments on the inside of the ankle, occur much less frequently. Medial ankle sprains cause throbbing pain on the inside of the ankle and result from the ankle rolling outward.
High ankle sprains are also unusual. They cause pain above the ankle, where ligaments connect the two lower leg bones. They are most common in people who play impact sports like hockey or football.
Tendonitis occurs when the tendons, which attach muscle to bone, become irritated and inflamed. There are three types of tendonitis that can happen in the ankle: peroneal tedonitis, posterior tibial tendonitis, and Achilles tendonitis.
Peroneal tendonitis is inflammation of the peroneal longus or peroneal brevis tendons. These two tendons run along the outside of the ankle joint.
A Lateral Ankle Sprain/tear Could Be Causing Outer Ankle Pain
Ankle sprains are more commonly seen in athletes, but can occur in anyone. A lateral ankle sprain occurs when you twist your foot and ankle in an inwards direction. This can cause the 3 ligaments mentioned previously to become stretched out and weak.
The anterior talofibular ligament is the weakest and is the first one to become injured, followed by the calcaneofibular ligament, and lastly the posterior talofibular ligament.
Occasionally, tears of the ligaments can occur. If there is an injury to all three ligaments, complete instability of the ankle joint may occur.
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How To Treat Peroneal Tendonitis:
Medication: Anti-inflammatory medication can help decrease swelling and increase the rate of recovery. It is very important to make sure that you consult your doctor before taking any sort of medication.
Immobilization: By decreasing movement of the affected area it will decrease tension on the tendons and allow them to heal faster.
Rest from aggravating activities: As this injury may be caused by repetitive movements, abstaining from these activities will allow the tendons to rest and heal.
Physical therapy: Perhaps the most important aspect of treatment will be ensuring that you have a comprehensive treatment plan in place. This will not only allow you to feel better much sooner, but it will also give you exercises to help prevent the injury from becoming recurring. Orthotics: Orthotic inserts have had positive in some patients that are diagnosed with peroneal tendonitis. These medical devices help give additional support to your feet and in turn help decrease tension on the peroneal tendons.
When Should I Call My Doctor About Ankle Pain
- Ankle pain is severe or doesnt go away after two to three days of at-home treatment.
- Pain and swelling come on suddenly.
- The area is red or warm to the touch, or you have a fever, which could be a sign of infection.
- You cant put weight on your ankle.
A note from Cleveland Clinic
Ankle pain is a symptom of many injuries and conditions. Swelling, stiffness and pain can make walking difficult or impossible. Most ankle injuries get better with treatments you can do at home, such as elevating your foot and getting plenty of rest. Ankle pain doesnt usually require surgery. If the pain is severe, you have a lot of swelling or the pain doesnt go away after a few days, see your provider. Several noninvasive treatments can help you get back on your feet.
- American Academy of Orthopaedic Surgeons. Sprained Ankle. Accessed 11/16/2020.
- American Academy of Orthopaedic Surgeons. Arthritis of the Foot and Ankle. Accessed 11/16/2020.
- American College of Foot and Ankle Surgeons. Ankle Pain. Accessed 11/16/2020.
- Merck Manuals. Ankle Fractures. Accessed 11/16/2020.
- Arthritis Foundation. Ankle Pain. Accessed 11/16/2020.
- American Orthopaedic Foot & Ankle Society. Chronic Lateral Ankle Pain. Accessed 11/16/2020.
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services.Policy
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Shooting Pain On Outside Of Ankle Other Causes
No doubt, the pain you may feel from your ankle can be excruciating and in discomfort. That is why we hope that the information we share can help relieve the pain and make healing possible.
If you continue to follow the recommendations we have for you, it will significantly benefit your health.
Check out these other medical conditions related to ankle pain.
What Conditions Are Like Peroneal Tendonitis
Tendonitis is just one of several conditions affecting the peroneal tendon. Others are:
- Acute tears. If the tissues of the tendon tear, you may experience weakness and instability of the ankle, as well as pain.
- Tendinosis. Sometimes, the tendon degenerates due to overuse, resulting in pain that comes and goes. The ankle may consequently be weak and unstable.
- Subluxation. This condition occurs when one or both of the peroneal tendons slip out of position. Besides the usual pain, swelling, and instability, you may feel a popping sensation as the tendon moves around the ankle bone.
Because pain in the foot and lower leg can have many causes, its important to see a doctor if you experience the symptoms described above.
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What Other Possible Treatment Options Are There
Its possible you have some unique biomechanical problems that are contributing to your case of peroneal tendonitis. Or you may require a different set of exercises to get back on track.
If this is one of a number of injuries, your running form may be to blame.
Our running form course will analyze this for you, to make sure injuries become a rare occurrence, rather than it being rare you are healthy. One of the main reasons runners end up with injuries is because they are overstriding. Make sure you read up on our Overstriding, Cadence, And Heel Striking post for more on this.
Both Heckman et al. and Selmani, Gjata, and Gjika suggest getting custom orthotics to take stress off the peroneal tendons.7, 10
Unlike many other injuries, it does seem like there should be a difference between custom orthotics and standard over-the-counter inserts like SuperFeet or PowerStep.
Usually, the goal of an insert is to support the arch, which transfers stress to the outside of the foot.
This can be very helpful in injuries like Plantar Fasciitis or Shin Splints. But in the case of peroneal tendonitis, this could be a bad thing. Remember, over eighty percent of people who get peroneal tendonitis have high arches.
Building up arch support even more, and shifting stress to the outside of the foot , could actually make the problem worse!
If your case of peroneal tendonitis isnt responding to rest and physical therapy exercises, a custom orthotic might be worth a shot.
What Are Peroneal Tendonitis Symptoms
The main symptom of peroneal tendonitis is swelling and pain around the ankle. You may also have pain on the outside of the foot and moving up the lower leg, making it hard for you to run or walk. You may also have a tender area just behind the ankle bone. Your pain may be worse early in the morning.
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Peroneal Tendonitis Or Peroneal Tendon Tear
There are 3 peroneal tendons that run along the outer side of the shin bone, across the lateral ankle, and connecting to the outer and underside of the foot. Their main function is to turn the foot out and down while acting as a stabiliser of the foot and ankle through motion. If they become overused through repetitive motion such as walking or running they can become inflamed and painful leading to Peroneal Tendonitis. Similarly, a sudden inversion of an ankle can cause a Peroneal Tendon Tear.
In the acute phase, Peroneal Tendonitis may be painful with all movements. In less acute episodes, it may be stiff and tender in the morning. During the activity, it may be tender initially while easing as it warms up. As the condition becomes more chronic it can become constantly painful. Peroneal Tendonitis is a common cause of outside ankle pain without swelling.
Treatment with a Physical Therapist or a Sports Medicine professional is recommended. The best form of treatment for Peroneal Tendonitis is strengthening exercises combined with modification to activity levels. Massage, stretching, and taping can provide temporary relief. We have covered Peroneal Tendonitis in-depth in this article and exercises for this condition here.
Tibialis Posterior Tendon Dislocation
Dislocation of the tibialis posterior tendon is rare in sport. It occurs when the tibialis muscle pulls the tendon out of its retinaculum. The retinaculum is the tissue which holds it in place on the inside of the ankle. Symptoms include:
- Moderate pain on the inside of the ankle.
- You may be unable to weight bear on the injured ankle.
Treatment involves immediate surgery to repair the retinaculum1. The ankle is then immobilised in a walking boot for 6 weeks. Then an ankle brace is used to provide protection and support. Ankle mobility exercises can begin.
However, it is important to avoid resisted inversion (turning your foot inwards against resistance as this could over-stress the inside of the ankle.
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Reasons For Outer Ankle Pain
One of the fun things to do in Orange County in the summer is to head to Huntington Beach for movies displayed on a huge, inflatable, outdoor movie screen with the latest in picture and sound technology. On July 16, you could take a picnic supper , watch the sunset, and then enjoy Raiders of the Lost Ark. Just be careful when you are stumbling back to your car lateryou dont want to end up with an ankle sprain or other injury!
Sprains are just one of the possible reasons for outer ankle pain. Twisting your ankle stretches the ligaments too far and can even tear them. If the sprain doesnt heal well, pain can become chronic, and weak tissues can make the ankle unstable and prone to future injuries. Besides ligament damage, here are some other common causes of ankle pain on the outside of your foot:
So take care this summer! If you are out and about and start feeling pain at the outside of your ankle, call Southern California Foot & Ankle Specialists and let us take a look at it. Treating the problem in the early stages may save you a lot of grief in the months and years to come. You can reach our office in Ladera Ranch at 364-9255 , or schedule your visit online, and head off disabling ankle pain before it takes hold.
Our practice treats all foot and ankle problems in infants, children, and adults. It is conveniently located in Ladera Ranch, CA.
How Do I Know If I Have A Peroneal Tendon Injury
Common symptoms of peroneal tendon injuries include:
- Pain on the outer ankle, which gets worse with activity such as walking, running, or pushing off the ball of the foot
- Swelling or tenderness behind the ankle bone
- Pain or weakness when pointing the toe or moving the foot outward
If you suspect a peroneal tendon injury, or you have any pronounced or persistent pain in your foot and ankle, see an experienced orthopedic foot and ankle specialist.
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Will You Need Surgery For Peroneal Tendonitis
If peroneal tendonitis doesnt improve with conservative treatments, you might need surgery. Surgery consists of cleaning out the damaged outer layers of tissue from your peroneal tendons during a procedure called a synovectomy. Some people may be candidates for a minimally invasive synovectomy, which involves smaller incisions and a faster recovery.
What Can Help With Peroneal Tendinopathy
The great news is that most peoples symptoms improve by following the recommended advice below, but it may take several months to get better.
If you have any of the contributing factors that can be changed it is important that you make the necessary changes to these. This will help your recovery.
Changing to comfortable running style trainers/shoes or hiking boots with a slight heel will provide the best support for the Peroneals. Try to avoid wearing hard, flat or unsupportive footwear. It is important to note that shoes that have flexible soles generally offer the foot less support and can increase the stress in the soft tissues of your foot and ankle. If your footwear has shoelaces make sure they are tied properly.
Most people with peroneal tendinopathy symptoms will improve within 3 months of following the recommended advice, however, symptoms can take up to 1 year to improve in some people.
It is also normal to have periods of increased pain or flare ups during your recovery.
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How Is Sinus Tarsi Syndrome Treated
In most cases, sinus tarsi syndrome pain can be treated conservatively with immobilization. Your doctor may suggest you wear an ankle brace to help reduce ankle motion.
Steroid injections can be beneficial in reducing pain.
If you have severely flat feet, your doctor may suggest custom orthotics to help elevate the arch of the foot and alleviate pressure along the sinus tarsi.
You should start RICE therapy and reduce activities for a few weeks. Your doctor may suggest physical therapy to help reduce pain and improve balance.
In rare cases, surgery may be needed for sinus tarsi syndrome. Surgery would be done in the operating room under anesthesia.
Your doctor would remove inflammatory tissue that is present in the sinus tarsi that is causing your pain. You will need to be immobilized in a cast boot after surgery for 4-6 weeks with minimal weight bearing, followed by physical therapy for a month.
Pain On Outside Of Lower Leg Above Ankle At Night Other Causes
Leg pain can be a bother as it limits your ability to walk and run. It can make you feel incapacitated as you cant do the usual stuff.
If you have such symptoms, it would be wise to address the problem immediately.
The sooner you get treatment, the better, as such injuries and conditions will take time to heal.
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Anatomy Of The Outer Ankle
The ankle bones are made up of the tibia , the fibula, and the talus.
On the outside of the ankle, there are three major ankle ligaments:
These ankle ligaments stabilize your ankle and prevent your ankle from inverting.
The peroneus longus tendon inserts at the 1st metatarsal base and medial cuneiform bone. The peroneus brevis tendon inserts at the fifth metatarsal base.
The sinus tarsi is the tunnel of space between the talus and the calcaneus bone. It contains connective tissue, fat, and nerve endings. The sinus tarsi help provides stability to the ankle joint.
How Is Peroneal Tendonitis Treated
Conservative treatments usually help relieve tendon pain and inflammation within three to four weeks. Recovery might take longer if tendonitis is the result of another injury, such as a sprain.
Common treatments for peroneal tendonitis include:
- Bracing: An ankle brace can support and stabilize your ankle if you have to perform certain movements, like running or jumping.
- Immobilization: You might need a soft cast or boot to immobilize your foot and take weight off your tendons so they can heal.
- Medication:Non-steroidal anti-inflammatory drugs can reduce pain and inflammation. In some cases, your provider might recommend steroid injections around the tendon itself, into the tendon sheath.
- Physical therapy: Physical therapists guide you through exercises and stretches to regain strength and flexibility in your foot and ankle. Your therapist might also recommend ice, heat or ultrasound therapy.
- RICE method: You can perform RICE at home. Rest by avoiding strenuous activities. Apply an ice pack or cold compress to your ankle for 20 minutes every two hours. Wrap your ankle in a compression bandage to reduce swelling and keep your ankle elevated, preferably above the level of your heart.
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