Beyond The Sprain, Unmasking a Rare Anterolateral Ankle Pathology in a Young Athlete

Chronic anterolateral ankle pain in young athletes is commonly attributed to ligament sprains, stress injuries, or tendinopathies. However, uncommon underlying pathologies may occasionally be responsible for persistent symptoms. Calcaneonavicular coalition is a congenital condition that can lead to chronic ankle pain and restricted hindfoot motion. The coexistence of calcaneonavicular coalition with a superficial ankle lipoma is extremely rare.

An 18-year-old female cricket athlete presented with gradually progressive swelling and pain over the anterolateral aspect of the right ankle for 5 years, affecting her sports performance. Clinical examination revealed a soft swelling with terminal restriction of dorsiflexion and limited hindfoot movements. Plain radiographs were obtained and demonstrated a calcaneonavicular coalition. Magnetic resonance imaging confirmed the presence of a superficial ankle lipoma along with the coalition. Surgical excision of the lipoma and resection of the calcaneonavicular coalition were performed through a single anterolateral approach. The extensor digitorum brevis muscle was interposed between the calcaneum and navicular to prevent re-ossification. Postoperatively, the patient regained full pain-free ankle motion and returned to sports within 12 weeks.

Persistent anterolateral ankle pain in young athletes should be carefully evaluated to rule out rare conditions such as tarsal coalition and soft-tissue tumors. Early diagnosis and appropriate surgical management can result in excellent functional recovery and return to athletic activity.