Our ankles carry the weight of our entire body and manage movement and motion with every step we take. They are easily among the most stressed joints in the body, so it’s easy to understand that ankle pain, particularly along the outside of the ankle, is quite common. Why the outside of the ankle? When we misstep or tweak or twist the ankle, most of the time our foot is naturally forced inward, which strains the outside of the ankle. Sometimes this stress is so subtle, we don’t even realize it’s happened, but over time, outside ankle pain can set in. Today we’re going to talk about what might be causing your outside ankle pain and what you can do about it.
Anatomy Along the Outside of the Ankle
There are a number of structures along the outside of the ankle that could become damaged and cause pain. First, the tendons. The outside of the ankle houses the peroneus brevis tendon and the and peroneus longus tendon. These small but critical tendons can become degenerated (i.e., tendinopathy) or torn, either of which can cause pain. Next we have the nerves. Nerves that start in the lower back and branch all the way down the leg and into the ankle and foot also supply this area, and an irritated nerve all the way up in the back can actually present as pain in the ankle, or anywhere else along the nerve branch.
Finally, we also have to look at the ligaments. The outside of the ankle houses the tibiofibular ligament, lateral ligament, and others, which are small but strong, and their primary job is to stabilize the ankle. These ligaments can become lax, or loose, and can also experience small tears, either of which can lead to outside ankle pain. Today, it’s these ligaments we want to focus on.
What Is Stress Ultrasound Imaging?
In order to best examine ligament strength, we need to be able to see them in motion on imaging. This means MRI, for example, which is a static technology, is not effective for this purpose. an MRI might show a large ligament tear, but we won’t typically see small tears or laxity.
This is why stress ultrasound is critical for properly diagnosing ligament issues. As we stress the ligament, we can visualize its response on stress ultrasound. This allows us to diagnose any instability that might be causing the outside ankle pain. Watch Dr. Centeno’s video below to see how this works.
As you can see in the video, when a loose ligament is stressed, we can see it give way and stretch beyond its normal limits; this is ankle instability. If it doesn’t stretch under the stress, ankle instability can be ruled out. These same loose ligaments would likely not be picked up by an MRI, and the diagnosis for the outside ankle pain would be missed.
Dr. Centeno used stress ultrasound imaging to examine this patient’s ankle (see the video above). The stress ultrasound revealed that it was indeed this patient’s 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 bones—the fibula and tibia—due 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.
Your ankle is located where the distal ends of the tibia and fibula bones (lower-leg bones) meet the talus bone at the foot. Between these bones are the ankle joints (e.g., tibiotalar, tibiofibular, subtalar, etc.). The ankle joint also consists of strong supporting tendons and ligaments. If you consistently experience ankle pain with walking or running or carrying a heavy load, this could be tendon inflammation, ligament instability, or arthritis in one of those joints.
The ankle is susceptible to injury. It is the most injured joint in sports and accounts for 10-30% of all sports injuries. A sprain (aka twisting the ankle) is when one or more of the ligaments is stretched or torn. Pain, swelling, and bruising are common. Sprains are classified into grades 1, 2, or 3 based upon the severity of the injury. Simple tasks like stepping off the curb or sports can lead to ankle sprains. Ligaments stabilize the ankle joint and when sprained can lead to ankle instability. When acute ankle sprains are not identified, treated, and allowed to heal chronic…
Have you been told you have an ankle tendon tear and need surgery? Do you really need this procedure or will less invasive injections do the trick? Let’s review ankle tendon surgery and who needs it and who doesn’t.
The ankle has many tendons that come from leg muscles. They help stabilize the ankle and move the foot up, down, left, and right.
The ankle tendons include:
FHL (Flexor Hallicus Longus)
FDL (Flexor Digitorum Longus)
These can be torn in trauma or due to wear and tear.
Disorders that affect and weaken the connective tissues such as tendons and ligaments. It is a hereditary disorder which means you are born with it. EDS has many different signs and symptoms which can vary significantly depending upon the type of EDS and its severity. It most commonly affects the skin, joints, and blood vessels. Joints are typically hypermobile with excessive joint range of motion because of a defect in collagen formation. In most cases Ehlers-Danlos syndrome is inherited. That is to say that you are born with it. The two main ways EDS is inherited are: autosomal dominant inheritance and autosomal recessive inheritance…
Your ankle is comprised of bones held together by a bunch of ligaments. These ligaments end up getting damaged when you sprain or roll your ankle.
Common causes are trauma or injury related, such as twisting your ankle.
Outside ankle pain can be treated without surgery by an interventional orthopedics physician. Loose or torn ligaments usually can be treated nonsurgically with ultrasound-guided high-dose platelet-rich plasma (PRP) injections (typically one to three treatments).
While loose or torn ligaments is a common issue causing outside ankle pain, keep in mind that the pain could also stem from a tendon or nerve problem. The key is to work with your interventional orthopedics physician so he or she can use the proper tools to help diagnose the root cause of your pain. Ligaments, nerves, or tendons, there is likely a nonsurgical regenerative medicine solution for your outside ankle pain.