Recurring or persistent pain on the outer side of the ankle often develops after an injury such as a sprained ankle. However, several other conditions may also cause chronic ankle pain.

Causes
The most common cause of a persistently painful ankle is incomplete healing after an ankle sprain. When you sprain your ankle, the connecting tissue (ligament) between the bones is stretched or torn. Without thorough and complete rehabilitation, the ligament or surrounding muscles may remain weak, resulting in recurrent instability. As a result, you may experience additional ankle injuries. Other causes of chronic ankle pain include:

• An injury to the nerves that pass through the ankle—The nerves may be stretched, torn, injured by a direct blow, or pinched under pressure (entrapment).
• A torn or inflamed tendon
• Arthritis of the ankle joint
• A break (fracture) in one of the bones that make up the ankle joint
• An inflammation of the joint lining
• The development of scar tissue in the ankle after a sprain—The scar tissue takes up space in the joint, thus putting pressure on the ligaments.

Symptoms
The most common symptoms of persistent ankle pain include:

• Pain on the outer side of the ankle that is so intense you have difficulty walking or participating in sports. In some cases, the pain is a constant, dull ache.
• Difficulty walking on uneven ground or in high heels
• A feeling of giving way (instability)
• Swelling, stiffness or tenderness

Treatment
Treatment will depend on the final diagnosis and should be personalized to your individual needs. Both non-operative and surgical treatment methods may be used. Conservative treatments include:

• Anti-inflammatory medications such as aspirin or ibuprofen to reduce swelling
• Physical therapy, including tilt-board exercises, directed at strengthening the muscles, restoring range of motion, and increasing your perception of joint position
• An ankle brace or other supportive device
• An injection of a steroid medication
• In the case of a fracture, immobilization to allow the bone to heal

If conservative treatment doesn’t bring relief or is not appropriate for your condition, your doctor may recommend surgery.