Ankle Pain Differential Diagnoses

Ankle pain persistent following injury

• Fractures - anterior process calcaneus, lateral process talus, posterior process talus (or, rare, os trigonum fracture), osteochondral lesion, tibial plafond chondral lesion, base of fifth metatarsal
• Bony impingements - anterior, posterior, anterolateral
• Atypical sprains - chronic ligamentous instability, medial ligament sprain, syndesmosis sprain (AITFL sprain), subtalar joint sprain
• Tendon injuries - chronic peroneal tendon weakness, peroneal tendon subluxation/rupture, tibialis posterior tendon subluxation/rupture
• Other - inadequate rehabiliation, chronic synovitis, sinus tarsi syndrome, complex regional pain syndrome type 1

Lateral Ankle Pain

• Peroneal Tendinopathy
• Sinus Tarsi Syndrome
• Impingement syndrome (anterolateral, posterior)
• Recurrent dislocation of peroneal tendons
• Stress fractures (talus, distal fibula)
• Referred pain (lumbar, peroneal nerve, superior tibiofibular joint)
• Cuboid Syndrome
• Complex regional pain syndrome type 1 (following knee or ankle injury)

Medial Ankle Pain

• Tibialis Posterior Tendinopathy
• Flexor Hallucis Longus Tendinopathy
• Medial Calcaneal Nerve Entrapment
• Stress fracture (calcaneal, talar, medial malleolarnavicular
• Tarsal Tunnel Syndrome
• Posterior Ankle Impingement
• Referred pain from lumbar spine
• Complications of acute ankle injuries
• Complex regional pain syndrome type 1 (following knee or ankle injury)

Posterior Ankle Pain

• Midportion achillles tendinopathy (this includes tendinosis, paratendonitis, and partial tears
• Posterior impingement syndrome
• Insertional achilles tendinopathy (including retrocalcaneal bursitis and haglund's disease)
• Sever's disease (adolescents)
• Achilles bursitis
• Accessory soleus muscles
• Referred pain (neural structures, lumbar spine)
• Achilles tendon rupture
• Achilles tendinopathy due to inflammatory arthropathies