What To Know and Do About Ankle Pain
Oleg Breslavtsev / Getty Images
Medically reviewed by Raynetta Samuels PT, DPT, CLT
Your ankle is where your calf bone (fibula), shin bone (tibia), and talus bone come together. It is considered a synovial joint, which is the term used for an area where bones move against each other. The ankle joint acts like a hinge to connect your foot to your leg, allowing movement. In addition to the tibia, fibula, and talus, your ankle has several ligaments (tough bands of tissue that connect joints). Your bones, ligaments, tendons, and other tissues can get injured, swollen, or infected, causing ankle pain.
Ankle pain can range from mild to severe, depending on the cause. While ankle pain may go away on its own, ongoing or worsening pain should not be ignored. Determining the cause through a medical exam and addressing it with proper treatment can help ease the pain and prevent long-term issues from happening.
How Ankle Pain Presents
The signs and symptoms of ankle pain vary from person to person based on what is causing the issue and its severity. Ankle pain may come on gradually with activity or suddenly after an injury. Ankle pain can occur when walking on the affected foot or moving the ankle around.
Ankle pain may feel like an ache or soreness. Some people with arthritis (a condition characterized by inflammation of the joints) in their ankles may experience pain and stiffness, among other symptoms. If the pain is a result of an ankle sprain, you may have intense pain, a lot of swelling, and be unable to walk. A type of arthritis called gout can cause intense pain, warmth, redness, and swelling. The pain may be severe, throbbing, or crushing, and start suddenly, often at night.
An ankle fracture (broken ankle) may cause immediate pain at the site that can extend from your foot to your knee. In the case of a fracture, it’s common to have swelling and bruising around the ankle joint and your leg, and you may not be able to walk or put weight on your ankle. However, in the case of less severe fractures, it may be possible to walk on the injured ankle.
Potential Causes of Ankle Pain
Ankle pain can be caused by many different factors ranging from mild to severe. The most common causes include sprains, fractures, arthritis, and tendinitis.
Ankle Sprains
The most common cause of ankle pain is an ankle sprain. An ankle sprain is when the ligaments that connect the ankle bones get stretched too far and sometimes tear. For example, you can sprain your ankle if you twist your foot while walking on uneven ground or land hard on your ankle when playing sports. Ankle sprains account for 15% of all sports injuries in the United States.
A moderate sprain will cause soreness and bruising. A more severe sprain may cause intense pain—especially when you try to walk—and significant swelling.
In some cases, an ankle sprain does not heal properly over time and instead becomes a chronic (long-term) issue. If that happens, you may feel continued pain and swelling in that ankle joint. Your ankle could feel weak or unstable, with a tendency to give way easily.
To avoid ankle sprains, warm up before playing sports or running, do exercises to strengthen your ankles, be careful when walking on uneven ground, and wear shoes that provide adequate support.
Fracture
Ankle pain can result from an ankle fracture. Ankle fractures can range from tiny cracks in a bone (stress fracture), to a simple break in one bone, to more serious breaks that require surgery. In addition to significant pain, a broken ankle can cause swelling, bruising, tenderness, and difficulty bearing weight on the injured ankle.
There are different ways an ankle fracture can happen. For example, suddenly twisting, rolling, or rotating the ankle while running or walking is a frequent cause. Tripping or falling from heights like ladders is another common cause of ankle fractures. High-impact sports or activities that involve sudden changes in direction or jumping can also increase your risk.
Ankle fractures can happen to anyone, but they're more common in adults. They happen most often in women aged 75 to 84 years old. In men, they are more common in the 15 to 24 age range.
Arthritis
Arthritis in the ankle can cause swelling, inflammation, pain, and stiffness over time. Several types of arthritis can cause ankle pain. They include:
Osteoarthritis: Osteoarthritis happens when the cartilage that cushions the joints gets worn down over time. As more cartilage frays and thins, there is less padding between the ankle bones. Eventually, bone rubs directly on bone, causing pain. Bony spurs can also form around the joint.
Rheumatoid arthritis: This chronic condition occurs when your immune system attacks healthy tissue in the joints. Rheumatoid arthritis in the ankle causes swelling and damage to ligaments and tendons. It can also cause deformity of the ankle joint. This can lead to ankle pain, instability, and disability over time.
Posttraumatic arthritis: This condition can develop after an injury, like a severe sprain or fracture. Similar to osteoarthritis, posttraumatic arthritis wears down the cartilage between the joints. This condition can appear years after the injury, causing ongoing pain.
Gout: Ankle pain can be caused by gout, a type of arthritis that occurs due to too much uric acid in the body. Uric acid is a waste product found in your blood. When uric acid builds up in the body, it can lead to crystals in your joints—including your ankles—causing pain and other symptoms.
Septic arthritis: Sometimes bacteria gets into a joint through the bloodstream or an open cut around the ankle. This causes what’s known as septic arthritis—an infected joint. With septic arthritis, you may notice inflammation, redness, warmth, fever, and severe pain in the affected joint.
Tendinitis
Tendons connect muscles to bones. They can become inflamed and irritated, and this condition is called tendinitis (sometimes spelled tendonitis).
A few types of tendinitis can cause ankle pain. For example, the peroneal tendons run along the outer side of the ankle and help move the ankle from side to side. When the peroneal tendons become irritated and swollen (peroneal tendinitis), you may experience pain in the outer ankle area. Sometimes, the ankle may feel unstable and tend to give way.
Another type of tendinitis that can cause ankle pain is Achilles tendinitis. The Achilles tendon connects the calf muscles to the back of the heel bone. You use your Achilles tendon to walk, run, or climb stairs. Achilles tendinitis occurs when the Achilles tendon becomes irritated and inflamed, leading to pain and stiffness at the back of the heel. Sometimes, the pain can spread to the back of your leg and ankle.
Diagnosis
Your healthcare provider will first ask about your symptoms and medical history to help them understand the cause of your ankle pain. They may ask questions about exactly where you feel pain in the ankle and any associated symptoms like swelling, redness, or fever. They want to know if any injury caused the pain and how it is impacting your ability to walk.
Your healthcare provider will also examine your ankle. They’ll check for tenderness in areas around the ankle joint, evaluate your flexibility, test your reflexes, and check your nerve function. They’ll also observe how you stand or walk.
Depending on the findings, your healthcare provider may order imaging to check bone alignment, problems in ligaments or cartilage, arthritis wear-and-tear, small fractures, or anything unusual. Imaging tests may include:
In some cases, such as if arthritis or infection is suspected, you may be asked to do blood tests. You may be referred to a podiatrist (a medical doctor who specializes in foot and ankle care) or an orthopedic surgeon (a medical doctor who specializes in the musculoskeletal system) for more specialized care.
When To See a Healthcare Provider
Minor ankle pain may heal on its own or with at-home care, such as rest and ice. However, it’s important to go to the hospital immediately if:
Your ankle hurts severely even without putting weight on it.
You think the ankle may be broken—it looks misshapen, or you can't stand on that leg.
You hear a popping sound from the joint, followed quickly by pain.
You can't properly move your ankle.
Call your healthcare provider right away if:
Swelling does not get better after 2 to 3 days
Signs of infection develop, like increasing redness, pain, or warmth around the ankle, or you have a temperature over 100°F
Pain continues for several weeks
You notice symptoms in other joints
You have arthritis and notice new symptoms
How Is Ankle Pain Treated?
Ankle pain treatment depends on the cause. You can treat the pain at home in some cases, such as a mild sprain. But certain causes of ankle pain require medical treatment and sometimes surgery.
At-Home Care
At-home care includes using the RICE method, which stands for rest, ice, compression, and elevation:
Rest: Rest the joint and avoid walking on it.
Ice: Use ice packs right away to reduce swelling. Apply ice for 10 to 20 minutes, three to four times a day. The swelling usually goes down in a few days.
Compression: Wrap your ankle with a compression bandage, like an ace wrap. This helps keep the joint still while providing support, which can reduce swelling.
Elevation: Try to keep the affected ankle elevated above your heart (you can do this by propping your foot on pillows while lying down) whenever you can, especially in the first 48 hours.
Over-the-counter pain medication like non-steroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) or Aleve (naproxen) may also help relieve discomfort and swelling.
Physical Therapy
Physical therapy (also called physiotherapy) is a type of care that focuses on helping you improve your physical function and mobility. It is often used to treat various conditions that cause ankle pain, such as sprains. You may also need physical therapy after ankle surgery. Physical therapy exercises help to rebuild flexibility, muscle tone, range of motion, and stability that may be lost after trauma.
Devices
Depending on the injury, your healthcare provider may recommend using crutches, a cane, ankle braces, orthotics, or a cast to help your recovery. For example, for a moderate sprain, your healthcare provider may put your ankle in a splint to prevent movement while it heals. You may be placed in a short leg cast or a walking boot for severe ankle sprains.
Surgery
Your healthcare provider may treat a simple ankle fracture by having you wear a protective boot. In some cases, surgery may be necessary to repair damaged structures. For instance, ankle arthroscopy—a minimally invasive surgery where a tiny camera is inserted to view and operate inside the ankle joint—can help reduce ankle pain and improve mobility.
With severe fractures, the broken bones may require realignment using screws, pins, rods, or plates for correct healing. This type of surgery is called an open reduction and internal fixation (ORIF).
Some people with ankle arthritis may need a total ankle replacement (ankle arthroplasty). In a total ankle replacement, the surgeon removes the damaged ankle joint and replaces it with an artificial one made of metal and plastic. An orthopedic surgeon will choose the most appropriate surgery for your injury.
A Quick Review
Ankle pain may be caused by ankle sprains, fractures, arthritis, or tendon swelling. Sprains are the most common reason for ankle pain. Mild ankle pain may improve with at-home rest and ice therapy. However, contact your healthcare provider if you notice worsening pain or swelling, signs of infection, or any new symptoms.
Go to the hospital right away for sudden severe ankle pain if the ankle looks misshapen or dislocated or if you’re unable to stand on the affected leg, as these may indicate a serious injury.
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