Lateral ankle pathologies

Red flag screening

• Sinister pathology
• Emergency conditions such as acute tendon rupture or fracture
• Osteomyeltis/infection/charcot
• Inflammatory arthropathies.

Consider

• Mechanism of injury
• Duration and severity in symptoms
• Change in symptoms.

Limitation of function
Swelling pattern and severity
Structural changes in foot.

• Assess passive and active range and quality of motion, bony tenderness, loss of sensation and muscle power.
• Assessment of ankle ligaments for instability: talar tilt teat and anterior draw test.
• Ottawa ankle fracture rules.

• Diagnostic ultrasound and MRI may be beneficial in assessment of ligamentous structures and tendon pathologies.
• MRI beneficial for assessing for osteochondral defects.
• Plain film X-rays beneficial if fracture suspected.
• Stress X-ray may be utilised to assess lateral ankle ligaments.

• Ligamentous injury
• Peroneal tendinopathy
• Tarsal coalition
• Cuboid syndrome
• Osteochondral lesions/defects
• Nerve entrapments
• Chronic lateral ankle instability
• Sinus tarsi syndrome.

Patient education and self management advice, with supporting literature including:

• Weight management advice if appropriate
• Activity modification and management advice
• Analgesia & non-steroidal anti inflammatory drugs as appropriate
• Exercise prescription
  • Intrinsic foot exercises
  • Calf/achilles stretches
  • Balance and proprioception
• Footwear advice
• Avoidance completely flat footwear, up to 1.5 inch heel height acceptable
• Advice on lacing techniques
• Increased width of heel sole / increase support around ankle, for lateral instability, running shoes with medial posting or rigid materials along the medial aspect should be avoided
• Heel raises - these should be given bilaterally so as to avoid leg length discrepancy.

• Failure of first line treatment
• Ambiguous diagnosis
• Worsening symptoms.