Everything you need to know about ankle pain


There are many potential causes of ankle pain, from acute injuries like sprains or ankle fractures to chronic conditions like ankle arthritis. In turn, the ways of experiencing such pain may be different. It can be burning, pain, or stinging, and it can also come on suddenly or gradually. This information will be of interest to your healthcare provider as it provides early clues as to what may be causing your ankle pain.

After a physical exam and possibly an imaging, you will proceed with a treatment plan, which may include simple measures such as resting and applying ice to the ankle, or measures that require more time, such as physical therapy or, in rare cases, surgery.

Illustration by Alexandra Gordon, Get Meds Info


The ankle joint is made up of bones, muscles, cartilage, and tissues called ligaments and tendons. Trauma or disease affecting any of these ankle structures can cause pain.

Ultimately, becoming familiar with these unique diagnoses can help you prepare for your PCP visit, be it your PCP, podiatrist , orthopedic surgeon , or emergency care provider.


If you experience pain in your ankle, it is most likely due to one of the following common reasons:


An ankle sprain is damage to one or more ligaments (the tough, fibrous tissue that connects bone to bone). Ankle sprains are common injuries that can occur when stepping off a sidewalk, walking on an uneven surface, falling, or during sports such as tennis or basketball, where a rapid change in direction causes the ankle to roll or twist inward. .

The most common ankle sprain is the anterior talofibular ligament (ATFL). When the lateral ligaments are stretched, a person develops a shooting pain on the outside of the ankle. There may also be swelling, bruising, and / or a feeling that the joint may be malfunctioning, especially if the ligament is completely torn.

Medial and superior ankle sprains are much less common than lateral ankle sprains. Medial ankle sprain causes stabbing pain on the inside of the ankle and is the result of the ankle turning outward.

A high ankle sprain causes pain above the ankle, where the ligaments connect the two bones in the lower leg. They arise from the rotation of the foot in relation to the leg and are seen more frequently in people involved in impact sports such as soccer.


Ankle tendonitis occurs when the tendons, where the muscles attach to the bone, become irritated and inflamed.

A common type of ankle tendonitis is peroneal tendonitis, which refers to damage to the peroneus longus or the tendons of the short fibula. These two tendons run along the outside of the ankle joint. People with a peroneus longus muscle or tendonitis often report a history of running on uneven or slippery surfaces or playing sports that involved rapid changes in direction.

Pain with long peroneal tendonitis or short tendonitis , often described as a dull ache or a tight feeling, is localized to the outside of the ankle, develops over several weeks, and worsens with standing or walking. Swelling can occur in more severe cases of tendonitis. Also, people sometimes describe a cotton sensation on the outside of the ankle.

Another type of tendinitis, posterior tibial tendonitis, usually causes gradual ankle pain on the inside of the joint along with swelling. If left untreated, posterior tibial tendonitis can lead to serious problems with walking. Although a twisting injury can cause posterior tendonitis, most people don't really remember the specific injury.

The Achilles tendon is the largest tendon in the body and connects the muscles of the lower leg and lower leg to the heel bone. Achilles tendonitis causes burning, squeezing pain in the back of the ankle. Mild swelling may also occur, as well as morning stiffness in the heel and lower leg.

Any activity that puts pressure on the Achilles tendon, such as playing sports that suddenly start and stop or change direction, can cause tendonitis. Wearing ill-fitting shoes, improper exercise, or having bone spurs in the heel can also lead to Achilles tendonitis.


There are three main types of arthritis that affect the ankle:

  • Osteoarthritis is a type of arthritis in which the cartilage in the ankle joint gradually breaks down. Over time, due to the loss of cartilage, the bones rub against each other. Bony growths (osteophytes) can also develop. Pain in osteoarthritis varies, but often begins with intermittent, aching sensations that turn into more acute and persistent pain over time.
  • Rheumatoid arthritis is an autoimmune disease in which a person's immune system attacks multiple joints throughout the body, including, in most cases, the foot and ankle. In addition to other joint damage, a person with rheumatoid arthritis may experience fatigue or unintentional weight loss from whole body systems.
  • Post-traumatic arthritis It can develop after any injury associated with the ankle and is similar to osteoarthritis in that the cartilage in the ankle begins to wear down.

Bone fracture

Ankle fracture (fracture) is common and refers to a fracture of one or more of the following bones:

  • Tibia (shin)
  • Fibula (shin)
  • Talus (foot bone)

As with an ankle sprain, twisting or rolling the ankle, tripping on a curb, or falling can cause an ankle fracture.

In addition to immediate and very sharp pain, other typical symptoms of an ankle fracture are swelling, bruising, and the inability to transfer weight to the ankle. If the ankle is dislocated in addition to the bone fracture, the ankle may appear deformed.

Bone contusion

Ankle injury is the result of less serious bone damage than a fracture. Ankle injuries can occur alone or in conjunction with ankle ligament sprains. They are often very painful and cause fracture-like swelling.


Although your healthcare provider will consider the following possible ankle pain diagnoses, they are not common.


Gout , a type of inflammatory arthritis, is the result of uric acid crystals forming in one or more joints. Since gout is a rare cause of ankle pain, it will be treated primarily in people who have an underlying diagnosis of gout.

Bone infection

Rarely, a bone infection (osteomyelitis) can occur in the ankle. Besides pain in the ankle, other signs of infected bone include warmth and swelling.

Tarsal tunnel syndrome

Tarsal tunnel syndrome refers to compression of the tibial nerve in the "tarsal tunnel" of the ankle (similar to carpal tunnel syndrome, which occurs in the wrist). This syndrome can cause pain or burning, numbness, or tingling in the sole of the foot, the toes, and sometimes the heel, ankle, or calf.

Peroneal neuropathy

The common peroneal nerve runs down the lower leg and branches into the deep and superficial peroneal nerves. Depending on where the nerve is compressed, a person will experience unique symptoms. For example, compression on the outside of the knee and upper leg, which can result from prolonged lying down during hospitalization or from crossing the legs too much, can cause the foot to drop .

Compression of the deep peroneal nerve causes lateral ankle pain and a burning or tingling sensation between the two fingers. This is a rare condition often caused by wearing a tight shoe strap.


Benign (benign) tumors of the foot and ankle, such as a synovial cyst, are not necessarily uncommon, but malignant (cancerous) bone tumors such as chondrosarcoma are rare.

When to contact a healthcare provider

If at any time you are unsure of the cause of your ankle symptoms or are unsure of specific recommendations for treating your condition, seek medical attention. In particular, these signs require an immediate examination by the attending physician:

  • Inability to walk comfortably on the affected side.
  • Injury causing deformity of the ankle.
  • Ankle pain that occurs at night or while resting.
  • Ankle pain that does not go away for several days.
  • Do not bend the ankle
  • Swelling of the joint or lower leg area.
  • Signs of infection, including fever, redness, and / or hot skin
  • Any other unusual symptoms


Many ankle conditions can be diagnosed with a medical history, physical exam, and x-rays. Other conditions require more extensive tests, including additional imaging tests and / or blood tests.

History of the disease

When discussing ankle pain with your doctor, try to provide as much information as possible. In fact, it's a good idea to think through these details before scheduling an appointment. Some thoughts to keep in mind include:

  • Where is your pain (such as lateral or medial ankle)
  • What is your pain (eg, Painful or sharp) and how severe (eg, Mild or severe)
  • How long does your pain last? Did it start immediately after the injury or did it appear gradually?
  • Do you have symptoms other than ankle pain, such as fever, fatigue, or numbness?

Physical exam

In addition to your medical history, your healthcare provider will perform a physical exam of your ankle. To begin, your ankle will be checked for swelling, bruising, or deformity. Then, they will perform specific tests related to the ankle, such as the following:

Ottawa Ankle Rules

The Ottawa Ankle Guidelines are used by emergency departments and primary care providers to rule out an ankle fracture in the event of an ankle injury.

In summary, these tests assume that your healthcare professional is pressing on the medial and lateral ankle (round bones that protrude from both the inside and outside of the foot). If you are in pain or if you are unable to bear weight immediately after an ankle injury and after four steps in the emergency room or doctor's office, an X-ray is needed to evaluate the fracture.

Talus tilt test

During this test, your healthcare provider will hold the heel of your sore ankle in his hand and then gently turn (twist) and twist (twist) your ankle. They compare the weakness of movement in the ankle with an intact ankle. Increased weakness or pain with eversion of the ankle suggests a possible lateral ankle sprain, while increased weakness or pain with eversion of the ankle suggests a possible medial ankle sprain.

Comprehension test

During this test, your healthcare professional will compress the bones in your lower leg to mid-calf. The test is positive and indicates an upper ankle sprain if pain is felt above the ankle.

Blood test

Blood tests may be ordered based on your healthcare provider's suspicions of a specific diagnosis. For example, if you suspect rheumatoid arthritis, your healthcare provider may prescribe a level of citrullinated anti-cyclic peptide (anti-CCP) . C-reactive protein (which looks for markers of inflammation) is the most common blood test ordered in this setting to rule out infection.


X-rays are often used to access ankle pain, primarily to distinguish an ankle sprain from a fracture. X-rays can also show signs of gout or osteoarthritis.

Sometimes other imaging techniques are also used, such as computed tomography (CT) or magnetic resonance imaging (MRI) . This is especially true when it comes to more complex diagnoses, such as an ankle sprain, bone tumor or infection, or a suspected fracture not visible on the initial X-ray.

To diagnose a nerve problem, such as peroneal neuropathy, a doctor who specializes in nerve disorders (neurologist) can perform nerve conduction studies and electromyography (EMG) .

Differential diagnosis

While it is reasonable to believe that ankle pain is related to a problem in the ankle itself (i.e., a ligament, tendon, muscle, or bone), this is not always the case.

Here are some examples of conditions that can cause ankle pain, but are not actually related to any ankle structure:


A blood clot in the calf (called a deep vein thrombosis ) can cause pain, swelling, and / or warmth in the ankle, foot, or lower leg. The good news is that Doppler ultrasound is a simple and quick test that a doctor can order to diagnose this serious but treatable condition.

Skin infection

A skin infection ( cellulitis ) of the foot, ankle, or lower leg can cause ankle pain, as well as fever, redness, swelling, and warmth. Although cellulite can often be diagnosed by a healthcare professional, a healthcare professional often only needs a medical history and physical exam, and sometimes certain blood tests, such as an elevated white blood cell count , are helpful.

Lumbar radiculopathy

Sometimes nerve pain around the ankle (burning or tingling) is not due to a nerve in the ankle, but rather to an irritated nerve in the lower spine. This condition, called lumbar radiculopathy , can be diagnosed with an MRI of the lower spine (lumbar).

Acute compartment syndrome

Acute compartment syndrome, a serious condition that results from a sharp increase in muscle pressure, often the result of a severe crush or bone fracture, can develop in the lower leg.

In addition to severe pain, other symptoms of acute compartment syndrome include numbness, tingling, and / or burning in the affected area.

Watch out

Treatment depends entirely on your specific ankle problem, but one of the common treatment plans for many ankle diagnoses is the RICE protocol. This protocol is a good first step before consulting your doctor.

RICE Protocol

The RICE Protocol is the standard home treatment for a variety of musculoskeletal injuries, including ankle sprains and ankle tendonitis. The acronym stands for four basic steps:

  1. Rest – The first treatment for most ankle diagnoses is to simply rest the joint and allow the acute inflammation to subside. Sometimes this is the only step necessary to relieve mild ankle pain. If the pain is severe, crutches can help.
  2. Ice – Ice packs or cold gel packs are some of the most common treatments for ankle pain and should be applied for 15 to 20 minutes three or more times a day to reduce swelling and relieve pain. Do not apply ice directly to your skin.
  3. Compression – Compression bandages , such as the ACE bandage, can help support and immobilize the ankle. However, do not over-tighten. Signs of excessive compression include numbness, tingling, increased pain, cooling, or swelling in the foot or ankle just below the bottom of the bandage or bandage.
  4. Elevation: Raising the ankle above the level of the heart (resting the foot on pillows) can help reduce swelling during the first two days after an ankle injury.

Support and stability elements

Depending on the type of injury, crutches or canes, anklets or splints, braces and / or cast may be required. The specific injury and its cause will determine which one your doctor recommends.


Physical therapy is commonly used for many ankle diagnoses, including sprains, tendonitis, and after ankle surgery. Physical therapists use a variety of rehabilitation exercises to increase the strength of the ankle muscles, restore mobility, minimize stiffness, and prevent chronic ankle problems.


Nonsteroidal anti-inflammatory drugs, commonly called NSAIDs , are some of the most commonly prescribed medications, especially for patients whose ankle pain is caused by problems like arthritis, sprains, and tendonitis. If the fracture is severe, stronger pain relievers, such as opioids , may be prescribed for a short time.

In severe cases of arthritis, cortisone , a steroid that reduces inflammation, may be injected into the ankle, although the injection is temporary.


Surgery may be required to treat certain ankle conditions. For example, if an ankle fracture is severe, an orthopedic surgeon will need to repair and put the ankle bones in place with screws, pins, rods, and / or a plate.

Arthroscopic ankle debridement

In the early stages of ankle arthritis, your surgeon may perform debridement, in which loose cartilage, inflamed tissue, and bone growth around the joint are removed. This surgery can be performed arthroscopically , in which the surgeon inserts a small camera into the ankle joint. The instruments can then be inserted through other small incisions to debride or "clean" the wound.

Ankle arthrodesis

Other ankle arthritis surgeries include arthrodesis, which involves fusing the ankle bones together to prevent movement of the arthritic joint, minimizing pain.

Ankle arthroplasty

Total ankle replacement is another type of ankle surgery. In ankle replacement, the surgeon removes the damaged cartilage and bone and replaces it with an ankle implant.


Maintaining good muscle strength and flexibility in the ankle is key to preventing many types of ankle-related injuries. Here are some simple strategies to help prevent ankle injuries:

  • Warm up before physical activity
  • Wear suitable footwear (such as basketball shoes for playing basketball and running shoes).
  • Using pain as a guide: If your foot or ankle hurts, slow down or stop the activity.
  • Maintain a healthy weight, as obesity can predispose to ankle tendonitis and put pressure on joints affected by arthritis.
  • Switch from high-performance aerobic sports to low-intensity sports like swimming to prevent your ankle problem from getting worse.

Get the word of drug information

Dealing with ankle pain and getting back on your feet can be easy or may require a more thorough evaluation. Either way, once you've been diagnosed, you can begin to develop a treatment plan – a step-by-step path to getting the pain reliever you deserve.

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