Pain behind the outer ankle bone after a crash

A foot and ankle surgeon and a physical therapist on peroneal tendon injuries

For survivors and families3 min read

Leg and foot injuriesPeroneal tendon injuriesTendon injuriesAnkle injuriesImaging and tests

Two peroneal tendons run behind the bony bump on the outside of your ankle. They help turn your foot and keep it steady. A twisting injury in a crash can hurt these tendons along with the ankle ligaments. [1, 2]

Some signs call for a second look. These include pain just behind the bump or weakness when you turn your foot outward. A sense of instability that won’t go away counts too. A normal X ray can’t show a tendon tear. [1, 2]

Find the exact source of the pain

Tell your doctor if the pain is right on the bone, just behind it or deeper in the joint. Mention any snapping, repeated giving way or pain that hasn’t improved the way a sprain should. The exam checks the tendons for tenderness and strength. Ultrasound or MRI may show a tear. Imaging can also help find other problems if the diagnosis is still unclear. [1, 2]

Treatment follows what the exam finds

A minor tendon problem may get better with a boot or brace, changes in activity and guided strength work. A significant tear or a mechanical problem that persists may lead to a talk about surgery. Ask what the plan is protecting. Find out when walking, balance work and harder exercise can move forward. Do not keep forcing your foot outward to test it. [1, 2]

When the ankle isn't following the usual course

Get rechecked if your ankle still hurts after the usual sprain recovery time. The same goes if it keeps giving way or swells more with activity. Get an urgent exam for a cold or blue foot or new major numbness. You also need one if you can’t bear weight after a new injury. [1, 2]

Questions about tendons and imaging

  1. Is my pain coming from a tendon, a ligament, bone or joint cartilage?
  2. Would an ultrasound or MRI change the plan?
  3. What activity should I avoid until we know the cause?

Show and tell at your next exam

At your next exam, point to the exact spot that hurts. Describe any snapping you’ve noticed. [1]

Sources and further reading

  1. 1American Orthopaedic Foot and Ankle Society, peroneal tendon conditions
  2. 2American Orthopaedic Foot and Ankle Society, ankle sprain

General education from foot and ankle surgery and physical therapy. Outer ankle pain that won’t go away has several possible causes. An exam, plus imaging when needed, can tell a tendon problem apart from a ligament or bone injury.

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