Overuse Injuries of the Ankle and Foot

Overuse injuries of the foot and ankle typically result from repetitive microtrauma rather than from a sudden sprain or a single impact, in which the cumulative load on tendons, fascia, bones, and surrounding soft tissues exceeds the tissues' reparative capacity. Repetitive lower extremity loading and complex movement patterns in sports such as soccer, basketball, gymnastics, and running increase the risk of overuse injuries. Common symptoms include swelling, pain, and limited mobility, which tend to worsen with continued activity. While conservative treatment is often sufficient, persistent pain and functional loss lasting at least 3 to 6 months, underlying structural anomalies (such as os trigonum or foot arch deformities), or significant structural damage (such as full-thickness tendon tears or cartilage injury) may necessitate surgery. Radiological imaging plays a vital role in diagnosing, planning treatment, and monitoring overuse injuries in the foot and ankle. This article covers the anatomy and biomechanics of the lateral ankle, including variations like low-lying peroneus brevis (LLPB), peroneus quartus (PQ), os peroneum (OP), as well as sinus tarsi syndrome (STS), metatarsal stress fractures, plantar fasciitis (PF), sesamoiditis, and posterior ankle impingement syndrome (PAIS).