Chronic ankle pain in both ankles despite ligament reconstruction – doctors are out of ideas

Hi everyone,

I’m posting because I’ve had chronic ankle pain in both ankles for about 3 years, and despite many tests, treatments, and even surgery, no one has been able to explain it. My surgeon recently classified my case as “complex”, and I’m trying to see if anyone has experienced something similar or has ideas of things to investigate.

Background
I'm a 24-year-old female from France.
As a child I had many ankle injuries in both ankles (sprains, fractures, tendinitis, frequent twisting). I’m also very hyperlax. Around age 11 the injuries stopped and my ankles were just very flexible (“elastic ankles”) but without pain.

Symptoms started in 2023
I began experiencing ankle and leg pain in the evenings, like the feeling after a long hike even though I’d only had a normal day. At first it was occasional, then it became almost every evening.
Main symptoms:

• pain starting just below the outer ankle bone (lateral malleolus)
• pain radiates up the leg (sometimes to the knee or even hip)
• worse in the evening
• sometimes wakes me up at night
• cold helps relieve it
• no specific movement triggers it
• affects both ankles equally

I also have muscle spasms in my legs, mostly in the evening, for several years (magnesium supplements never helped).

First medical investigations
A sports medicine doctor examined me and said my ankles had almost no stability. Imaging showed:

• very lax ligaments
• an accessory bone fragment in the right ankle from an old trauma

I had 6 months of physiotherapy, but the pain continued to increase.

Surgery (June 2024)
A foot and ankle surgeon performed:

• ligament reconstruction (ligamentoplasty) on the right ankle
• removal of the accessory bone fragment

The surgery went well and my right ankle is now mechanically stable.
However, by September 2024 the exact same pain came back in BOTH ankles.

More investigations
Tests done after surgery:

• bone scintigraphy → normal
• CT scan → normal
• MRI → showed anterolateral gutter syndrome on the right ankle

I received a cortisone injection, which relieved the pain for only 3 days.
MRI of the left ankle showed some scar tissue but not enough to explain the pain.

Current situation
My surgeon says the surgery worked mechanically and he doesn’t know what is causing the pain anymore.
I had a consultation with three surgeons together, and their new hypothesis is that my foot position may be causing pressure in the ankle (they suspect flat feet with inward collapse).
However, my podiatrist strongly disagrees and says I actually have high arches (pes cavus). She modified my orthotics anyway but after one month there is no improvement.

Impact on my life

• daily pain in both ankles
• I had to stop dancing after more than 15 years
• I plan my days around pain
• it’s becoming mentally exhausting

My questions
Has anyone experienced something similar, especially:

• chronic ankle pain despite ligament reconstruction
• anterolateral ankle pain with mostly normal imaging
• pain in both ankles
• hyperlaxity involved

Or does anyone know other conditions that could explain this type of pain?
At this point I’m just trying to find possible directions to investigate.

Thank you for reading.