The continuous movement of running is great for heart, but it can be stressful on the joints, including the ankles. Even more so, a slight deviation in running form, such as overpronating, can lead to injuries and serious pain. Lateral ankle pain during running is common, but it is difficult to pinpoint the cause. If chronic pain stifles your running regimen, talk to your doctor to learn more about the cause and treatment options.
Peroneal Tendinopathy
The peroneal tendon runs along the lateral ankle, just outside the bony malleolus of the ankle. The tendon attaches the peroneus longus muscle to the back of the lateral malleolus and under the foot. Tendinopathy, or tendonitis, is an overuse injury. The Sports Injury Clinic outlines five main symptoms: pain and swelling on the outside of the ankle or heel, pain worsening with activity, pain when pressing on the tendon, pain when the foot is inverted or everted and tight calf muscles. Causes of peroneal tendiopathy include running along slopes or overpronating the foot during running.
Lateral Ligament Injuries
Lateral ligament injuries, or ankle sprains, occur with quick change of direction on uneven surfaces. In the "Encyclopedia of Sports Medicine and Science," Karim Khan and Peter Bruker state that lateral ligament injuries occur when the foot is excessively inverted and plantarflexed and can occur in varying severity. Grade I injuries cause a minor tear to the ligament but no laxity. Grade II injuries tear the ligament with laxity, but the ligament is still firmly attached to the bone. Grade III injuries have extreme laxity with no firm attachment point. Lateral ligament injuries cause instability of the ankle and pain along the lateral aspect of the foot, ankle, and leg. Follow the RICE principles -- rest, ice, compression and elevation -- if you experience a lateral ligament injury. More severe injuries may require follow up and treatment from your doctor.
Sinus Tarsi Syndrome
Richard Bouché, D.P.M., defines sinus tarsi syndrome as a clinical disorder of the opening on the outside of the foot between the ankle and heel bone. This syndrome can be caused by a lateral ligament injury or overpronating during running. Symptoms include instability and increased pain with weight-bearing activity and pain with palpation of the sinus tarsi. Treatment starts with the RICE principles and may continue with customized orthotics, oral steroids, physical therapy or surgery.
Nerve Entrapment
Nerve entrapment, or chronic nerve compression, of the peroneal nerve can occur with overpronating during running or with inversion injuries, such as a lateral ligament injury, as noted M.R. Lowdon from the John Radcliffe Hospital in Oxford. Symptoms of nerve entrapment include numbness and tingling along the lateral aspect of the calf, ankle and foot, as well as pain with palpation of the lateral malleolus. Treatment can be difficult with nerve entrapment but should begin with the RICE principles with emphasis on rest. Surgery may be needed to release the compressed nerve.
References
- The Sports Injury Clinic: Peroneal Tendionpathy
- "Encyclopedia of Sports Medicine and Science": Ankle Acute Injuries; Karim Khan and Peter Bruker; March 1998
- "American Academy of Podiatric Sports Medicine"; Sinus Tarsi Syndrome; Richard Bouché
- John Radcliffe Hospital: Superficial Peroneal Nerve Entrapment; M.R. Lowdon
