The main structure is the ankle joint itself. The ankle joint runs transversely at a level a little above the tips of the malleoli. Later you can palpate to confirm it is the actual source of pain. Constant pain here is usually dies to arthritis or trauma; episodic pain may be due to impingement, arthritis, or repeated injuries.

Above the ankle is the distal tibia and, laterally, the syndesmosis and the fibula. Below it is the talonavicular joint - patients often complain of "ankle pain" which is actually coming from the talonavicular joint. Often examination is necessary to be sure of the difference.

More superficially lie the dorsiflexor tendons. Anterior tibia tendonopathy is less common than posterior tibial tendonopathy but occurs in the same age group. Paratendonitis of the dorsiflexor tendons occasionally happens after an injury, in patients with inflammatory arthropathy or after a change in activities

Very occasionally the patient will describe severe, neuropathic type lancinating pain and tingling related to the superficial or (more rarely) deep peroneal nerve. The onset is often related to an injury or surgery, such as ankle arthroscopy.