If the pain is anterior then articular (joint) surface injury and anterior ankle impingement should be considered.
Articular surface injury may involve cartilage alone (chondral) or cartilage and bone (osteochondral). These patients will usually experience pain with walking, running and jumping activities. The pain is often worse with stairs or uneven ground. There may be start up pain where the patient has pain when he/she starts an activity such as running and the pain eases as the patient continues. With these lesions, the talar dome is more frequently injured than the tibia. Other symptoms with these lesions include ankle swelling, stiffness, weakness or giving way. If the damage is on the inner side of the ankle then the pain is usually on the inner side. However if the damage is on the outer side of the ankle then the pain is usually on the outer side.