Lateral Ankle Pain: Causes and Treatment Options

Pain on the outer posterior side of both ankles?

Doctor: Hello! Initially, I experienced pain in my right ankle (on the outer posterior side), which hurt while walking, but I don't recall any significant injury.
I went to a traditional Chinese medicine clinic for treatment, but there was no noticeable improvement during the process.
Then, my left ankle also started to feel sore, and after a month with no improvement, I went to the orthopedic department of a hospital for an X-ray.
The doctor said there were no abnormalities in the bones and diagnosed it as tendonitis, prescribing medication.
However, there hasn't been much improvement.
If I walk a bit more or by the evening, both ankles become sore, and sometimes the soreness extends to my calves.
Blood tests also ruled out gout.
It has now been over two months, and I am unsure of the cause.
Thank you for your help!

Ms. Tseng, 20~29 year old female. Ask Date: 2007/10/07

Dr. Chen Xingyuan reply Orthopedics

Dear Ms.
Tseng,
There are many causes of ankle pain, such as tendon and ligament sprains, fractures, joint disorders, tumors of the bone or soft tissue, neuropathy, gout, rheumatic autoimmune diseases, infections, and tendonitis due to improper use or overuse, all of which can lead to discomfort in the ankle.
Based on your letter, the most likely cause of your ankle pain is tendonitis resulting from improper use or overuse.
Therefore, I recommend the following:
1.
Reduce unnecessary walking or activities as soon as possible.
2.
When walking or engaging in activities, avoid prolonged, hurried, or intense movements to prevent re-injury.
3.
Use protective gear or bandages for support.
4.
Apply ice during the acute phase and heat during the non-acute phase.
5.
Choose shoes that are flat, loose, and comfortable; avoid high heels.
6.
If the pain persists and is severe, consider medication for treatment.
7.
Each time your symptoms worsen, reflect on possible causes and make necessary corrections.
Sometimes, it’s not that healing is impossible, but rather that the opportunity for healing has not been given.
Repeated injuries or inflammation can lead to chronic sprains or tendonitis, which means that even slight increases in activity or distance can cause ankle pain.
Please take care.
Wishing you peace and health!
Sincerely,
Dr.
Chen

Reply Date: 2007/10/07

More Info

Lateral ankle pain can be a frustrating and debilitating condition, especially when the cause is unclear and conventional treatments have not provided relief. Based on your description, it seems that you are experiencing pain on the outer side of your right ankle, which has now also affected your left ankle. You mentioned that there was no significant injury, and despite treatment from a traditional Chinese medicine clinic and a visit to an orthopedic doctor, you have not seen much improvement.

There are several potential causes for lateral ankle pain that may not be immediately obvious. Here are some common conditions to consider:
1. Tendinitis: Inflammation of the tendons around the ankle, particularly the peroneal tendons, can cause pain on the outer side of the ankle. This condition can arise from overuse, repetitive motions, or even improper footwear.

2. Ankle Sprain: Even if you do not recall a specific injury, it is possible to have a mild sprain that did not cause significant swelling or bruising. Ankle sprains can lead to lingering pain and instability.

3. Peroneal Tendon Injury: The peroneal tendons run along the outside of the ankle and can become strained or injured, leading to pain and discomfort.

4. Synovitis: Inflammation of the synovial membrane, which can occur in response to overuse or injury, may lead to pain and swelling in the ankle.

5. Osteoarthritis: Degenerative changes in the ankle joint can lead to pain, especially if there is a history of previous injuries or wear and tear.

6. Referred Pain: Sometimes, pain in the ankle can be referred from other areas, such as the knee or lower back. This can complicate the diagnosis.

Given that you have already undergone X-rays and blood tests to rule out gout, it may be beneficial to consider further imaging studies, such as an MRI, to assess the soft tissues around the ankle. An MRI can provide detailed images of the tendons, ligaments, and other structures that may not be visible on X-ray.

In terms of treatment options, here are some strategies that may help alleviate your symptoms:
- Rest and Activity Modification: Avoid activities that exacerbate the pain. Gradually reintroduce movement as tolerated.

- Physical Therapy: A physical therapist can provide targeted exercises to strengthen the muscles around the ankle, improve flexibility, and enhance stability.

- Ice Therapy: Applying ice to the affected area can help reduce inflammation and pain, especially after activity.

- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Medications like ibuprofen can help manage pain and inflammation.

- Orthotics or Supportive Footwear: Proper footwear or custom orthotics can provide additional support and alleviate stress on the ankle.

- Corticosteroid Injections: If inflammation is significant, a corticosteroid injection may provide relief.

- Alternative Therapies: Some patients find relief through acupuncture or other alternative therapies.

It is essential to follow up with your healthcare provider, especially if your symptoms persist or worsen. They may recommend further evaluation or a referral to a specialist, such as a sports medicine physician or a rheumatologist, if an underlying systemic condition is suspected.

In conclusion, lateral ankle pain can arise from various causes, and a thorough evaluation is crucial for effective treatment. With the right approach, many patients can find relief and return to their normal activities. Please keep an open line of communication with your healthcare team to ensure the best possible outcome.

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