Causes of pain in lower leg above ankle
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Common Causes of Lower Leg Pain Above the Ankle
Pain in the lower leg just above the ankle can have many causes, often involving structures other than the ankle joint itself. The pain may originate from ligaments, tendons (such as the Achilles tendon), the tibia or fibula bones, tendon sheaths, or even the skin in the area. It is important to note that the source of pain is often not the ankle joint, but rather the surrounding tissues and structures in the lower leg and hindfoot region .
Overuse Injuries and Syndromes
Overuse injuries are a frequent cause of pain in the lower leg above the ankle, especially in athletes and people whose jobs require prolonged standing or walking. Common overuse conditions include:
- Shin splints (medial tibial stress syndrome)
- Chronic anterior compartment syndrome
- Achilles tendon injuries (tendinopathy, enthesitis, rupture)
- Retrocalcaneal bursitis
- Tibialis posterior syndrome
These injuries often result from repetitive stress on muscles, tendons, or their attachment points to bone, leading to inflammation and pain 2346.
Stress Fractures and Bone-Related Pain
Stress fractures of the tibia or fibula are another important cause, particularly in athletes. These small cracks in the bone develop from repetitive impact and overuse, leading to localized pain that worsens with activity 34.
Nerve Entrapments
Entrapment of nerves in the lower leg, such as the saphenous nerve or other peripheral nerves, can cause pain, tingling, or numbness above the ankle. These conditions are less common but should be considered, especially if the pain is accompanied by neurological symptoms 34.
Vascular Causes: Popliteal Artery Entrapment Syndrome
Popliteal artery entrapment syndrome (PAES) is a rare but significant cause of lower leg pain, especially in athletes. It is characterized by recurrent pain in the back of the leg and sometimes foot tingling, often triggered by exercise. PAES is caused by abnormal positioning of the muscles near the artery, leading to restricted blood flow. Symptoms may include a cool sensation in the leg and decreased pulses during certain movements 345.
Tendinopathies and Bursitis
Tendinopathies (inflammation or degeneration of tendons) and bursitis (inflammation of fluid-filled sacs near joints) are also common sources of pain above the ankle. The Achilles tendon and the tendons of the tibialis posterior and long flexor of the toe are frequently involved 234.
Osteochondral Defects
Osteochondral defects, which are injuries to the cartilage and underlying bone in the ankle, can cause deep pain during weight-bearing activities. The pain is thought to result from increased pressure and fluid flow in the subchondral bone beneath the cartilage defect, stimulating pain-sensitive nerves .
Conclusion
Pain in the lower leg above the ankle can result from a variety of causes, most commonly overuse injuries, stress fractures, nerve entrapments, vascular issues, tendinopathies, bursitis, and osteochondral defects. Accurate diagnosis often requires a careful clinical history, physical examination, and sometimes imaging studies. Most cases can be managed conservatively, but some may require surgical intervention if symptoms persist 1234567.
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