Ankle Pain

Ankle pain can occur from the tendons or ligaments around the ankle as well as cartilage problems of the ankle joint.

Tendons around the Ankle

Pain on the outside of the ankle can sometimes be caused by injury to the tendons that are coming from the calf to the foot, running just behind the bone that forms the outside of the ankle joint (fibula). These tendons are called the peroneal tendons. The peroneal tendons are stabilized by the peroneal retinaculums which can also sometimes be torn. Pain at the back of the ankle can be caused by injuries or inflammation of the big tendon called the Achilles tendon as it inserts into the bone of the foot (Achilles tendonitis). Inflammation of fluid sacs (bursitis) around the achilles tendon is a common cause of pain at the back of the ankle.

Figure: Ankle showing structures which can cause ankle pain

Ligaments around the Ankle

There are many ligaments around the ankle. On the inside of the ankle, the main ligament is the deltoid ligament. On the outside of the ankle, the commonest ligament that is affected is the anterior talofibular ligament (ATFL). Both these ligaments can be injured by an ankle sprain. Just above the ankle joint, there are important ligaments called the tibiofibular ligaments which stabilize the 2 shin bones (tibia and fibula) to form the ankle shape. A “high” ankle sprain injures these ligaments which can cause pain.

Cartilage problems around the Ankle

The ankle bones have cartilage on their surface to allow smooth motion. Injuries to the cartilage, sometimes with bony injury (osteochondral injury) can cause pain. Some of these injuries can cause fragments of cartilage alone or cartilage attached to bone (Osteochondral fragment) to float around the ankle joint causing pain and inflammation. Advanced degeneration of the cartilage of the ankle joint can cause ankle joint arthritis which can cause pain. Sometimes, degeneration can occur after an ankle injury or due to inflammation.