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I have a friend that has recently injured her foot. She is generally quite sedentary and following a long walk she developed medial and lateral ankle pain. She has a flexible foot that pronates excessively in RCSP. the pain she is experiencing on her medial ankle below the medial maleolus and extending into the navicular area of the midfoot makes me think this is posterior tibial tenosynovitis ( am I correct). The pain she experiences on the lateral ankle below the lateral maleolus makes me think that it is the result of a problem related to the peroneal tendons or sub fibular impingement, however, as the foot is excessively pronating I do not see how this affects the peroneal tendons , therefore can anyone please enlighten me as to the correct diagnosis of this condition, she also states that the pain occuring in the lateral ankle radiates up into her thigh. Advice please.

? sinus tarsi syndrome

I doubt that is is the ankle joint that is hurting, but more likely the subtalar joint. If she has a hypermobile flatfoot, with significant transverse and/or frontal plane motion, then I would agree with craig that sinus tarsi pain is more likely. Otherwise palpate the lateral aspect of the posterior facet of the subtalar joint for pain. Try your best to palpate the *exact* anatomy that is painful.

Sounds to me like classic PTTD. I would suggest trying an orthotic with a varus rearfoot posting at first. The lateral ankle pain which radiates is likely secondary to impingement of the ankle capsule secondary to pronation.

But why is the lateral ankle pain radiating up the leg into the buttocks and lumbar area, is it possible to have pain associated with nerve entrapment proximal to the site of the entrapment

Have you done slump test for neural tension problem?

__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia
http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________
God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University
This is where I am, where are you?

can you please explain slump test for neural tension problem

Anyone with vague lateral foot or leg pain should be tested with the slump test for adverse neural tension and sent to physio if +ve.

Google search for slump test

__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia
http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________
God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University
This is where I am, where are you?

Lateral hindfoot pain associated w/PTTD - as mentioned above, probably sinus tarsi related sx; peroneal tendon/suran nerve impingment; I've had several cases of fibular stress fractures; although rare in my exoerience, could be lateral ankle gutter pain. Diagnostic marcaine injections can nail your diagnosis and obvious treatments as mentioned above. Good luck. Jeff

is lateral gutter pain the same thing as lateral ankle/fibular calcaneal impingement pain. Also, please explain the results expected from marcane injections and why this proceeure is performed.

lateral ankle gutter - intra-articular ankle joint sx between the fibula and talus vs fibular calcaneal impingement vs. sinus tarsi syndrome. Pain relief from diagnostic anesthetic injections will help with location of the sx.