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Where is the ankle located?
The lateral ankle is the terminal, protruding part of the fibula - one of the bones of the lower leg. It is located on the lateral, or outer, side of the foot, at the level of the ankle joint. It is this bone that can be seen and felt on the leg, near the ankle joint. The ankle and shin joint (upper ankle) is made up of three main bones: the tibia - forms the internal structure of the ankle joint, ending in the medial ankle, visible on the inside of the ankle joint, the fibula - forms the lateral ankle on the outside of the joint and connects to the tibia, with a strong ligamentous connection - the ligamentous ligament, and the ankle bone - which is located below the tibia and fibula.
These three bones come together to form the ankle joint, which mainly allows dorsiflexion and sole flexion of the foot, but also, together with movements in other joints, allows more complex movements of the foot (inversion/version and pronation and supination). In addition to the bones, this joint is stabilized by numerous ligaments and is surrounded by muscles that, working together, allow mobility and stability of the ankle joint. This entire musculoskeletal system supports the body's weight, helps you stand, maintain balance and move.
What can be the causes of lateral ankle pain?
- Sprains and sprains of the ankle - the most common cause of pain when the ligaments around the ankle are overstretched or torn, usually by twisting the foot inward (an overly supinated motion).
- Fractures - a crack or fracture of the fibula in the ankle region can cause acute pain, swelling and difficulty or inability to walk.
- Tendinopathies - inflammation or degeneration of tendons, especially the tendon of the long or short fibula muscle, can lead to pain in the lateral ankle area.
- Degenerative changes - degenerative changes in the cartilage of the ankle joint, usually post-traumatic, can cause pain and stiffness in the ankle joint.
- Ligamentous area - pain in the projection of the ligamentous tuberosity, the joint between the tibia and fibula, can cause discomfort in the ankle area.
- Nerve disorders - ankle pain may be related to damage to a nerve in the area, such as the fibula or calf nerve.
Diagnosing the specific source of ankle pain usually requires clinical evaluation, including a physical examination and sometimes additional imaging studies such as X-rays, MRI or ultrasound. Depending on the cause, treatment may include rest - a pause in training, physiotherapy, the use of painkillers or anti-inflammatory drugs, and in some cases even surgical intervention.
What are the symptoms of a lateral ankle fracture?
- Sensation of a snap or crack - at the time of the fracture, a person may feel or hear a snap.
- Severe pain - most often the pain is sharp and intensifies a lot when putting weight on the foot, often making it impossible to move.
- Swelling - the area around the fracture can swell very quickly.
- Hematoma in the subcutaneous tissue - bruising and redness may appear around the site of injury, indicating damage to smaller blood vessels, extravasation of blood into the soft tissues.
- Deformity - the ankle may look unnaturally positioned or deformed if the fracture is displaced, or accompanied by a dislocation in the joint.
- Inability to walk - often the person is unable to put the foot on the ground or walk without assistance.
- Increased sensitivity - the area around the fracture may be extremely sensitive to touch or pressure.
If a lateral ankle fracture is suspected, medical advice should be sought as soon as possible. The standard diagnostic procedure is to take an X-ray to confirm the fracture and determine its type. Treatment may include immobilization, administration of painkillers and sometimes surgical intervention, depending on the type and severity of the fracture.
How can an ankle fracture occur?
- Leaping - a high jump ending with a landing on the foot, especially when it is misaligned, can generate excessive forces leading to an ankle fracture.
- Twisting the foot - a violent inward or outward twisting of the foot can exert excessive force on the ankle, causing a fracture.
- Direct trauma - a blow to the ankle, such as during a car accident or a heavy object falling on the foot, can cause a fracture.
- Fall - tripping or slipping, especially when the foot lands in an unusual position, can cause an ankle fracture.
- Chronic overloading - fatigue fractures can occur as a result of long-term overloading of the ankle, often in people who participate in endurance sports.
- Weakened bones - osteoporosis or other conditions that cause weakened bones can make even a minor injury or normal stresses enough to cause a fracture.
How is a broken ankle treated?
Treatment of a broken ankle depends on the type and severity of the fracture and the patient's overall health. The most important thing is immobilization of the ankle joint. For fractures without displacement, immobilization with a cast or splint for 4 to 8 weeks is sufficient for the ankle. In some cases, instead of a cast, it is possible to use an orthopedic shoe that allows partial weight bearing on the foot. For fractures with displacement, multiple fractures or unstable fractures, surgery may be required, which often involves the use of metal screws, plates, nails or wires to stabilize the broken bones.
In the subsequent treatment of a broken ankle, rehabilitation plays an important role. Exercises, performed under the guidance of an experienced physiotherapist, are key to restoring range of motion, muscle strength and overall function of the foot and ankle. This process, which involves gradually putting weight on the limb, must be monitored and follow the doctor's instructions to ensure proper bone healing. During treatment, ankle pain may still be experienced, so the doctor may assign painkillers and anti-inflammatory drugs to reduce inflammation and swelling. The patient should also be instructed to avoid activities that may interfere with the healing process, avoiding putting weight on the injured ankle to ensure conditions for recovery.
What are the pathologies of the fibular muscle tendons?
Ankle pain can be associated with pathology of the fibular muscles. This is related to their anatomical position - the long fibula muscle and short fibula muscle lie on the lateral side of the calf and run side by side up to the ankle joint, where they encircle the lateral ankle. Pathologies of the fibular muscle tendons are various conditions that can be divided into three groups: tendon damage, inflammation of the fibular tendons and their sheaths, and instability of the fibular tendons.
- Tendinitis - inflammation of the tendon, which is most often the result of overuse, trauma or overload, and manifests as pain, swelling and tenderness along the tendon.
- Tendinosis - is a more chronic form of tendon injury, resulting from microtrauma and degeneration of the tendon tissue, often due to lack of adequate recovery time after chronic overuse.
- Tendon rupture - a complete or partial break in the continuity of a tendon can occur as a result of sudden trauma or a long-term degenerative process.
- Tendon subluxation - The peroneal tendons can become unstable and move from their normal position in the bony groove, often leading to pain and dysfunction.
- Tendinopathies - pathologies at the point of attachment of the tendon to the bone, can include both inflammation and degenerative changes in the tendon attachment.
Sagittal muscle tendon pathologies - symptoms
- pain in the ankle joint occurring at rest and worsening during physical activity,
- swelling of the ankle joint behind the lateral ankle,
- increased warmth associated with inflammation,
- restricted mobility of the foot,
- instability of the ankle joint with jumping of the fibula muscles.
How are fibular muscle tendon pathologies treated?
Treatment of fibular muscle tendon pathologies usually begins with conservative methods, such as rest, changes in physical activities, the use of anti-inflammatory drugs and the use of the PRICE procedure, i.e. ice, compression, elevation of the limb, temporary immobilization of the ankle joint (orthosis). In chronic cases or when the above methods fail to improve, it is possible to use platelet-derived growth factor (PRP) injections, shock wave therapy and, in extreme cases, surgical intervention. However, the key element is rehabilitation to strengthen muscles and improve tendon flexibility to prevent recurrence.
Related articles:
- Ankle sprain
- Learn about other possible foot and ankle injuries.
Bibliography:
- Healthline - What to Know About Ankle Pain - Medically reviewed by Gregory Minnis, DPT, Physical Therapy — Written by Natalie Phillips — Updated on November 9, 2019
- HSS - Chronic Ankle Pain: Symptoms, Causes and Treatments - By Jensen Henry, MD - 2023
- Medical News Today - What causes sudden ankle pain without injury? - Medically reviewed by Adam Hotchkiss, DPM — Written by Sarah Vevers on February 17, 2023
