Recurring or persistent (chronic) pain on the outer (lateral) side of the ankle often develops after a twisting injury. Pathology affecting a number of different structures, either alone or in combination, can explain this pain.

Commonly injured tissues include:

  • Ligament
  • Tendon
  • Bone
  • Cartilage (joint surface)
Other causes of chronic pain in the ankle include:

  • Scarring within the joint, causing impingement
  • A loose body in the joint, such as a piece of broken-off cartilage or bone
  • Inflammation of the joint lining, known as synovitis
  • Evolving osteoarthritis

Symptoms and signs

  • Pain, usually on the outer side of the ankle. This can be constant or episodic.
  • Instability. A sensation of looseness, weakness or impending giving way.
  • Intolerance of certain footwear eg. high heels
  • Swelling
  • Stiffness
  • Tenderness
  • Intolerance of uneven ground

Evaluation and diagnosis

The first step for a doctor, in identifying the cause of chronic ankle pain, is taking a history of the condition. Questions, such as the following, may be asked:

  • 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?
  • What makes the pain better or worse?
A thorough examination of the injured part is an integral part of the assessment process.

As there are so many potential causes for chronic ankle pain, one or two of a number of different investigations may be performed in order to pinpoint the diagnosis. Imaging such as x-ray, bone scan, computed tomography (CT) scan, or magnetic resonance imaging (MRI) may be needed. Often it's only then that a treatment plan can be formulated!

Treatment

Treatment will depend on the final diagnosis and should be personalised to an individual’s needs. Both nonoperative and surgical treatment methods may be used.

Non-operative methods include:

  • Splintage, such as a CAM boot
  • Physiotherapy, focusing on the rehabilitation of movement, strength and balance
  • An ankle brace
  • Anti-inflammatory medication
  • Activity modification and lifestyle changes
Operative treatments include:

  • Arthroscopic surgery
  • Ligament reconstruction
  • Fracture reduction or excision
  • Tendon repair, transfer or decompression
The recovery process after an operative procedure varies, depending on the size and nature of the operation. Some patients are allowed to begin standing and walking immediately, whilst others may require weeks of splintage and crutch-use. Physiotherapy treatment is often required during the rehabilitation phase.

Preventing re-injury

Whilst the risk of any re-injury will depend on the underlying condition, some general principles are worth considering.

Following a ligament reconstruction for instability, wearing an ankle brace (sports brace) whilst training and competing in sports which involve running and pivoting, for at least the first few months, can help prevent further injury. Similarly, wearing sturdy, supportive, well-fitting shoes and avoiding loose, rough and unstable surfaces can be beneficial!

High impact, pivoting sports should always be avoided until an ankle is fully rehabilitated! This means an absence of stiffness, weakness and balance problems, with all other activities. A good physiotherapist is ideally placed to give the “green light” for a return to sport, always in a graded fashion.

  All surgical procedures involve risks. The information provided here is for general educational purposes only. For specific advice regarding a chronically sprained ankle, please book an appointment with Dr Newman.

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