0:00 The ankle joint is formed by the bones of the leg, the tibia and the fibula, 0:16 and then 0:16 the foot, the talus. 0:19 Lateral ankle pain is common, and the most common cause is an ankle sprain. 0:24 However, there are other causes which we will explore. 0:33 The outer ankle or the lateral ankle have many important structures that we 0:37 need to revise. 0:39 These include the distal fibula which forms the lateral malleolus, lateral lig 0:44 aments that 0:45 help resist foot moving inwards, so inversion. 0:52 These lateral ligaments are the anterotelofibular ligament, calcaneofibular lig 0:58 ament, and the 0:59 posterior talofibular ligament. 1:05 The perineal tendons that are formed by the perineal muscles, they wrap under 1:10 the lateral 1:11 malleolus. 1:15 The sinus tarsi and the base of the fifth metatarsal, the fifth toe. 1:25 And so the lateral ankle or outer ankle pain can be caused by problems in any 1:30 one of these 1:31 areas. 1:32 Let's look at some common causes of pain in the outer ankle. 1:43 Lateral sprain is where you have injury to the lateral ligaments of the ankle 1:48 joint, usually 1:49 from an inversion injury. 1:53 Foot is moved inwards, usually this heals slowly by itself with rest. 2:05 Lateral ankle sprains that don't improve may mean another underlying injury 2:08 that occurred 2:09 with the sprain, such as a damaged cartilage, fracture, impingement syndrome, 2:15 perineal tendon 2:16 issues such as tendonopathy, rupture or dislocation, and then sinus tarsi 2:26 syndrome. 2:28 Let's talk about anterolateral impingement syndrome, which is a cause of 2:31 lateral ankle 2:32 pain. 2:33 This condition is most commonly the result of soft tissue scar buildup in this 2:39 specific 2:39 location after prior injury to the ankle. 2:43 The tissues effectively gets pinched or sandwiched between the talus and the t 2:51 ibia and/or the 2:51 fibular bones, as the available space decreases during certain movements, 2:58 mainly dorsiflexion. 3:00 And so dorsiflexion will obviously elicit the pain. 3:04 The lunge test, which causes the pinching of the tissue in between the talus 3:10 and tibia, 3:11 is positive and reproduces that discomfort. 3:21 Ostragonum syndrome is referred to as posterior ankle impingement syndrome. 3:29 An ostragonum is the result of a fracture of part of the posterior lateral tala 3:35 tubercle 3:35 or an unfused ossicle. 3:38 Typically, an ostragonum is asymptomatic. 3:43 However, it can become symptomatic following an overuse injury or ankle trauma 3:48 in athletes 3:49 and dancers, performing repetitive, forced plantar flexion, such as in ballet 3:57 dancing. 3:58 And the idea or the thought is that as a result of this, it causes pinching of 4:05 the surrounding 4:06 tissue against the ostragonum causing the pain. 4:11 So pain is mainly the posterior ankle, worse with plantar flexion, because you 4:16 're compressing 4:18 that area, and you get tenderness at the postural lateral ankle region. 4:30 Fracture is obvious cause of lateral ankle pain, and inversion injury can lead 4:35 to fracture 4:36 of the distal fibula, causing pain in the lateral aspect of the ankle. 4:42 The proximal fifth metatarsal is the site of a number of fractures that can 4:46 cause lateral 4:47 ankle pain. 4:49 These include a vulsion fracture of the proximal fifth metatarsal, Jones 4:55 fracture, and stress 4:56 fracture. 4:58 Because the blood supply may be disrupted, this can lead to poor bone healing. 5:09 Perineal tendinopathy is another cause of lateral ankle pain. 5:13 Perineal tendinopathy is irritation to one or both the perineal tendons, with 5:18 subsequent 5:19 degeneration and inflammation. 5:22 In the ankle, there are two important tendons on the lateral aspect. 5:27 These are the perineus longus and the perineus brevis tendons. 5:33 The perineus also means fibularis, so it can be called perineus or the fibular 5:40 is tendons. 5:41 The two tendons run immediately posterior to the lateral malleolus, and both 5:46 tendons 5:47 act to evert the ankle, and can be injured with ankle inversion. 6:00 The perineus longus tendon crosses along a groove in the cuboid and inserts on 6:06 the base 6:06 of the first metatarsal and medial cuneiform. 6:11 The perineus brevis, brevis meaning short, the perineus brevis tendons insert 6:16 at the base 6:17 of the fifth metatarsal, so it's a lot shorter. 6:26 Several factors can contribute to developing perineal tendinopathy, including 6:31 previous ankle 6:32 ligament strains, you know, when you roll the ankle inwards. 6:38 First of the heel, where you have over-supernation, perineal tendinopathy 6:49 causes pain on the 6:50 outer side of the ankle, particularly during physical activity. 6:55 Symptoms tend to reappear when the ankle is passively turned inwards, because 7:01 you're irritating 7:02 that tendon as you're moving the foot in. 7:07 The pain can also come when force is applied to turn it outward, so meaning 7:14 that the tendon 7:15 normally wants to move the foot outwards, but against resistance it will 7:20 trigger that 7:21 pain. 7:27 Another cause of lateral ankle pain is perineal tendon subluxation. 7:31 The perineal tendons, like many tendons in the body, are held in place by 7:35 supportive 7:36 connective tissue, such as ligaments or the retinaculum. 7:41 If the supportive tissue has been damaged or injured from recurrent inversion 7:47 injuries, 7:48 the tendon may be free to slip out of its normal position, and this is called 7:53 subluxation. 7:54 The tendons usually relocate by snapping back into place. 8:01 Finally, perineal tendon tears can occur, acute or chronic from repeated in 8:08 version injuries 8:10 can cause micro tears to the perineal tendon. 8:19 Sinostasis syndrome is a bit complicated, but in the front and below the 8:24 lateral malleolus, 8:25 there's a tiny bony passage that connects the talus and calconyl bones. 8:33 This passage is a crucial component of the subtailor joint and houses the subt 8:37 ailor ligaments. 8:39 It can sustain injury either from a sudden inward twisting of the foot or from 8:44 ongoing 8:45 strain caused by excessive pronation of the subtailor joint. 8:51 Symptoms include pain aggravated by E version, so the foot outwards, local tend 9:02 ons over the 9:03 sinus tarsi, pain induced by forced passive inversion, and the diagnosis is 9:10 confirmed 9:11 by injecting local anesthetic in there. 9:20 So, in summary, lateral ankle pain has many causes, including ankle sprain, 9:25 which is the 9:25 most common and inversion injury, impingement syndromes, and we talked about 9:32 the anterior 9:33 impingement syndrome, a fracture perineal tendonopathy, as well as sinus tarsi 9:39 syndrome. 9:50 in the back.
