The ankle is one of the most versatile joint complexes in the body. It is specifically built for weight bearing, mobility, adaptability, and stability. The foot and ankle allow us the ability to walk, stand, and serve as our connection to the ground. The ankle must be able to withstand the stress of body weight and adapt to / react quickly to changes in the environment and walking surface.
Generally, your ankle ligaments have many important tasks, which are to:
- Stabilize your ankle joint.
- Stop your ankle from moving in any unsafe or unnatural directions.
- Keep the bones in the proper position.
- Connect the bones of your foot with your lower leg.
- Absorb shock when your foot strikes a surface.
There are three sets of ligaments within your ankle, such as:
- Medial ligaments – Also known as deltoid ligaments, these ligaments begin at the medial malleolus (the end of the tibia, which forms the bump on the inside of your ankle). Then four ligaments fan out to connect to the talus, calcaneus, and navicular bones.
- Lateral ligaments – The lateral ligaments begin at the lateral malleolus (the end of the fibula, which forms the bump on the outside of the ankle). Additionally, three ligaments connect to the talus and calcaneus.
- Syndesmotic ligaments – This set of four ligaments connects the tibia and fibula.
Lateral ankle pain is inflammation of the peroneal tendons which are located on the outside of your ankle. Lateral ankle pain occurs through overuse, normally in athletes who use their ankles excessively. It can also occur through improper training techniques.
Peroneal tendon injuries affect the tough bands of tissue in the foot that connect muscles to bones. Most people typically have two peroneal tendons in each foot, running parallel to each other behind the lateral ankle bone. One peroneal tendon attaches the exterior side of the midfoot by the smallest toe, while the other runs beneath the foot and attaches close to the inside of the foot’s arch.
Causes & Symptoms of Lateral Ankle Pain
Lateral ankle pain may be acute (occurring suddenly) or chronic (developing over time). They most commonly occur in individuals who participate in certain sports that involve repetitive ankle motion. Basic types of lateral ankle injuries are tendonitis, tears, and subluxation.
Tendonitis
Tendonitis is an inflammation of one or both tendons. The inflammation is caused by activities involving repetitive use of the tendon, overuse of the tendon, or trauma (such as an ankle sprain). Symptoms associated with peroneal tendonitis include pain, swelling, and warmth to the touch.
Acute tears
These are caused by repetitive activity or trauma. Some immediate symptoms of acute tears include pain, swelling, and weakness or instability of the foot and ankle. Additionally, if time goes on as you leave your tear untreated, these tears may eventually lead to a change in the shape of the foot in which the arch may become higher.
Degenerative tears (tendonosis)
Degenerative tears are normally due to overuse and occur over long periods of time, often years. In degenerative tears, the tendon is like toffee that has been overstretched until it becomes thin and eventually frays. Having high arches also puts you at risk of developing a degenerative tear. The symptoms of this condition may include sporadic pain on the lateral side of the ankle, weakness or instability inside the ankle, and an increase in the height of the arch.
Subluxation
Subluxation means one or both tendons have suddenly slipped out of their regular position. In some cases, subluxation is due to a condition in which a person is born with a variation in the shape of the bone or muscle. In other cases, subluxation happens following trauma, such as an ankle sprain. Damage or injury to the tissues that stabilize the tendons can lead to chronic tendon subluxation. The symptoms of subluxation include intense pain behind the lateral side of the ankle bone, ankle instability or weakness, and a snapping feeling of the tendon around the ankle bone.
Who gets Lateral Ankle Pain?
Various risk factors linked to lateral ankle pain can increase your chances of developing peroneal tendon injury, including the following below:
- Sports – Many people who participate in sports (such as soccer, basketball, rugby, lacrosse, cross-country, and football) are all at a greater risk for lateral ankle pain, thus leading to peroneal tendon injuries and complications.
- Occupations – Occupational workers who are required to stand or walk for an extended periods of time are at an increased risk of lateral ankle pain due to trauma or overuse.
- High arches – Some individuals are born with high arches which can lead to a higher rate of lateral ankle injuries.
- Tight calves – Having tight calves can increase your likelihood of sustaining peroneal tendon injuries.
- Age – Patients older than the age of 50 have a chance of developing degenerative tears (tendonosis) in their peroneal tendons.
How Does Lateral Ankle Pain Affect You? How Serious is it?
If you leave your lateral ankle pain untreated after experiencing trauma, the pain can become chronic and recur as soon as it is increasing in intensity. Therefore, lateral ankle ligament reconstruction may be required to release once your pain has reached a severe level.
You might need this surgery if one or more of the ligaments on the lateral side of your ankle has loosened or stretched. This leads to a condition called chronic ankle instability. It can cause chronic pain, repeated ankle sprains, and an ankle that often gives way when you walk or perform activities.
Every surgery has its very own risks. Some of these risks that can present themselves from a later ankle ligament reconstruction include:
- Excess bleeding
- Nerve damage
- Infection
- Stiffness in your ankle joint
- Blood clots
- Complications from anesthesia
- No improvement in your ankle stability
Certain lateral ankle injury complications depend on your age, the anatomy of your foot, and your overall health. It is recommended to seek medical attention from a healthcare provider about any concerns you may have before proceeding with a lateral ankle ligament reconstruction.
Recommended Treatment & Rehabilitation for Lateral Ankle Pain
During a diagnosis of lateral ankle pain, some lateral ankle injuries are sometimes misdiagnosed and may worsen without any proper treatment, therefore, prompt evaluation by an orthopedic doctor is advised. In order to diagnose a lateral ankle injury, your doctor will carefully examine the foot and look for pain, instability, swelling, warmth, and / or weakness on the lateral side of the ankle.
In addition, an X-ray, computed tomography (CT), or magnetic resonance imaging (MRI) scans may be ordered to fully evaluate the injury. Your doctor will also look for signs of an ankle sprain and other related injuries that sometimes accompany lateral ankle pain. Proper diagnosis is an important procedure because prolonged discomfort after a simple ankle sprain may be a sign of additional problems.
After a diagnosis, it is essential to get proper treatment for lateral ankle pain as soon as it occurs. Any muscle-tendon connection with ongoing symptoms and loss of function can become more serious. With early diagnosis, physiotherapy can successfully treat your lateral ankle pain. Therefore, a physiotherapist will design an accurate treatment program to speed your ankle recovery.
Your treatment program for lateral ankle pain may include:
Patient education
Your physiotherapist will educate you on how to gradually increase and control your training regimen. This guidance will help reduce any chance of future injury.
Managing your symptoms
Your physiotherapist will help you identify and avoid symptoms related to painful movements of the peroneal tendon complex. Ice packs, ice massage, or moist heat may be used for pain management. You may also receive treatments like iontophoresis (a medication that is delivered through an electrically-charged patch) and ultrasound.
Supporting equipment
Your physiotherapist will recommend proper footwear for the activities you enjoy to ensure your ankles and feet get the best support needed. It may also be necessary to get fitted for a custom-made foot orthotic to reduce stress on your tendons. In severe cases, a foot brace may be ordered to help immobilize your injured ankle for several days until your pain has subsided.
Manual therapy
Your physiotherapist may use hands-on techniques to gently mobilize the joints in your foot, ankle, and lower leg. Soft-tissue mobilizations may be performed to loosen tightness, increase circulation, and relieve pain and swelling.
Range-of-motion exercises
You will learn exercises to help the ankle, foot, and toes move properly. These exercises will help improve the way you walk or run. Stretching exercises will help ease any tightness in the calf muscles and the tissues at the bottom of the foot.
Strengthening training
Generally, walking or running on uneven surfaces (such as grass, sand, gravel, or trails) requires a lot of strength to avoid added stress on the ankle. Therefore, your physiotherapist will teach you resistance exercises with bands, weights, or medicine balls. These exercises will help strengthen your ankle, foot, and lower leg muscles.
Function training
As your symptoms, strength, and motion improve, your physiotherapist will help you return to your regular level of activity. You may learn sport-specific exercises to improve your movements. Your physiotherapist will also design a personal home-exercise program for you to continue to perform after your physiotherapy sessions have finally ended.
Here are some exercise examples for you to try at home:
Calf wall stretch (back knee straight)
Begin by standing and facing a wall with your hands on the wall at about eye level. Next, put your affected leg about a step behind your other leg. Keeping your back leg straight and your back heel on the floor, bend your front knee and gently bring your hip and chest toward the wall until you feel a stretch in the calf of your back leg. Hold the stretch for at least 15-30 seconds, then repeat 2-4 times a day.
Calf wall stretch (knees bent)
Stand facing a wall with your hands on the wall at about eye level, then put your affected leg about a step behind your other leg. Keeping both heels on the floor, bend both knees. Next, gently bring your hip and chest toward the wall until you feel a stretch in the calf of your back leg. Hold the stretch for at least 15-30 seconds, then repeat 2-4 times a day.
Shin muscle stretch
Sit in a chair, with both feet flat on the floor. Bend your affected leg behind you so that the top of your foot near your toes is flat on the floor and your toes are pointed away from your body. Hold the stretch for at least 15-30 seconds, then repeat 2-4 times a day.
Alternative & Homeopathic Treatment for Lateral Ankle Pain
Certain treatments depend on the type of lateral ankle pain. So, here are a few options you can try to boost your recovery of the condition:
- Immobilization – A cast or splint may be used to help keep the foot and ankle from moving and allow the injury to heal.
- Medications – Oral non-steroidal anti-inflammatory medications (NSAIDs) or pain-relieving creams may help reduce pain and inflammation.
- Ice/heat application – Applying an ice pack for 20-30 minutes can help reduce swelling and inflammation. Additionally, heat packs are useful to increase blood circulation.
- Foot shower – Placing your affected foot in a bucket filled with warm water can help relieve your foot pain and increase blood flow. Adding Epsom salt will increase recovery speed.