Unresolved lateral ankle pain. It's not always 'just a sprain'

Lateral ankle sprains are the most common sports related injury. Unfortunately a number of other lateral ankle injuries are often misdiagnosed as a sprain, resulting in misdirected therapy, delayed functional return and unresolved ankle pain.

This review focuses on the differential diagnosis and management of unresolved lateral ankle pain, with an emphasis on methods to correctly identify the injury.

A surprisingly long list of conditions can mimic a lateral ankle sprain, including syndesmosis sprains, subtalar sprains with or without instability, impingement lesions, chronic ankle instability, osteochondral lesions of the talus, peroneal tendon injury, tarsal coalition and fractures of the hindfoot. A careful history, anatomically accurate palpation and plain erect X-rays are the cornerstone of diagnosis. The key is to remember that it's not always just an ankle sprain. Bone scintigraphy, CT and MRI are valuable investigational adjuncts. Arthroscopy is an excellent method of intra-articular visualisation to diagnose and treat unresolved lateral ankle pain.