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Ankle Bone or Joint Injury

What Causes Outside Ankle Pain?

Minute Read


Posted 2 years ago


Last updated: 03/12/2022


by James McCormack

Outside ankle pain is common in runners and all walks of life. There are numerous structures and conditions that can cause outside ankle pain and in this article, we will cover the signs, symptoms, and treatment of some of the more common conditions that lead to outer ankle pain.

Lateral Ligament Sprain

There are 3 main ligaments on the outside of the ankle. Their primary function is to provide stability to the outside of the ankle and provide stability on uneven surfaces. Ligaments are non-contractile tissues and they connect bone to bone. The lateral ligaments of the ankle are some of the most commonly sprained ligaments in the body, especially the Anterior Talofibular ligament (ATFL) and the Calcaneofibular Ligament (CFL).


These ligaments are most often injured through inversion or inward rolling of the ankle joint. This motion can stretch and tear these ligaments. Tears of ligaments are graded from 1-3 with 3 being the worst. A clinical diagnosis can be achieved through a consultation with a Physical Therapist or a Sports Medicine Doctor. If they are uncertain, they may refer for an Ultrasound scan or an MRI to confirm the diagnosis.


In the acute stage, ice and early mobility are recommended while high-graded tears may be placed in an ankle brace. Treatment consists of graded strengthening and mobility exercises guided by a Physical Therapist.

Diagram of lateral ligament ankle sprain

Sinus Tarsi Syndrome

Sinus Tarsi Syndrome is a painful condition on the outside of the ankle that can sometimes get confused as a lateral ankle sprain. The subtalar joint consists of two bones, the talus, and the calcaneus. The Sinus Tarsi is a small tunnel that passes through the articulation of these bones. Within this tunnel, there are nerves, tendons, sinus tarsi ligaments, and blood vessels that when irritated can become painful. This may be the result of trauma to the area or from an unstable ankle.


Sinus Tarsi Syndrome symptoms include pain and tenderness over the area that is often aggravated by walking on uneven surfaces, impact, and pain on palpation.


Treatment includes physical therapy, taping, mobilizations of the ankle, and strengthening and balance exercises. If this fails to settle the symptoms, a steroid injection may be required.

Sinus Tarsi Syndrome

Peroneal Tendonitis or Peroneal Tendon Tear

There are 3 peroneal tendons that run along the outer side of the shin bone, across the lateral ankle, and connecting to the outer and underside of the foot. Their main function is to turn the foot out and down while acting as a stabiliser of the foot and ankle through motion. If they become overused through repetitive motion such as walking or running they can become inflamed and painful leading to Peroneal Tendonitis. Similarly, a sudden inversion of an ankle can cause a Peroneal Tendon Tear.


In the acute phase, Peroneal Tendonitis may be painful with all movements. In less acute episodes, it may be stiff and tender in the morning. During the activity, it may be tender initially while easing as it warms up. As the condition becomes more chronic it can become constantly painful. Peroneal Tendonitis is a common cause of outside ankle pain without swelling. 


Treatment with a Physical Therapist or a Sports Medicine professional is recommended. The best form of treatment for Peroneal Tendonitis is strengthening exercises combined with modification to activity levels. Massage, stretching, and taping can provide temporary relief. We have covered Peroneal Tendonitis in-depth in this article and exercises for this condition here.

Picture diagram of Peroneal Tendonitis

Lateral Malleolus Stress Fracture

The lateral malleolus which is also known as the distal fibula is a common site of stress fractures of the foot. It is more prevalent in high-impact activities but can occur innocuously in those with low bone density or low vitamin d levels.


Lateral Malleolus Stress fracture symptoms often include a sharp pain around the outside of the ankle when walking, weight-bearing, or running. There may be some swelling and bruising in the area. An Orthopaedic consultant may refer you for an x-ray to confirm the diagnosis. If this returns as normal, an MRI or CT Scan may be required.


Treatment typically consists of 4-6 weeks in a walker boot followed by 4-6 weeks of Physical Therapy.

x-ray of Lateral Malleolus Fracture

Physiotherapy with James McCormack

This is not medical advice. We recommend a consultation with a medical professional such as James McCormack. He offers Online Physiotherapy Appointments for £45.

Related Articles 

Sinus Tarsi Syndrome
Inner Ankle Pain
Dancer’s Heel 
Peroneal Tendonitis

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