Ankle sprains are the most common ankle injuries in the adult population. In fact, it is estimated that at least one million such injuries occur every year in the United States.

Most people recover quickly and easily from ankle sprains. But a small number go on to develop long-term, chronic ankle pain. In this article, orthopedic surgeons specializing in foot and ankle problems help identify some of the more common causes of chronic ankle pain.

The authors advise using an anatomical approach. This will help doctors diagnose and classify problems and plan the best treatment. The ankle is divided into four sections. These are medial and posteromedial, posterior, lateral, and anterior. Pain in each of these areas can be caused by specific lesions.

Pain on the medial and posteromedial area (inside of the ankle) can be caused by tendonitis or nerve compression. The two tendons involved most often include the posterior tibial tendon (PTT) and the flexor hallucis longus (FHL). Tendonitis can lead to ligament damage and foot and ankle deformity.

Tarsal tunnel syndrome (TTS) can cause pain in the medial and posteromedial ankle when the tibial nerve is pinched or pressed. TTS can be the result of trauma, fracture, tumors, cysts, and other soft tissue problems. The most common symptoms of TTS are burning pain and numbness on the bottom of the foot.

Anterior (front of the ankle) pain occurs most often after significant ankle trauma. Bone fragments or loose pieces of tissue inside the joint cause pain from impingement (pinching) of structures during movement. Arthritis with bone spurs and cysts can also narrow the joint space. This results in similar symptoms from impingement.

And finally, pain along the lateral side (outside of the ankle) can occur with tendon subluxations or tears. Subluxation refers to slipping of the tendon out of the groove in the bone where it normally slides during motion.

Treatment for any of these ankle conditions is conservative. The management tools may include anti-inflammatory drugs, physiotherapy, change in activities, and rest. Heel lifts, splints, bracing, and injections are also used.

If none of these help, then surgery may be needed. There are over 50 possible operations that can be used in the management of chronic ankle pain. Tendon transfers, ligament repairs, or ankle joint replacement are common methods used to reconstruct and stabilize the ankle.