What is causing my ankle pain?

Ankle pain is pain, tenderness or discomfort in or around your ankle joint. It can have several causes including injury, overuse, or an underlying medical condition. Your ankle is a complex joint that joins your lower leg to your foot. It is made up of bones, muscles, ligaments, tendons, cartilage, nerves, and blood vessels. Your ankles move in two directions, dorsiflexion (upwards towards your body) and plantarflexion (downwards away from your body). Your ankles allow you to keep your balance and maintain stability and flexibility when moving. 

We use our ankles every time we stand, walk, run, or jump and it’s little wonder that ankle pain is so common. In this blog, we’ll look at some common causes of ankle pain, and how ankle pain is diagnosed and treated. 

Ankle pain after an injury

Ankle pain following an injury such as a sprain, strain or fracture is common and frequently occurs during sports where you suddenly change direction such as football or basketball. Ankle injuries can also occur if you misstep or your ankle rolls inwards while walking. Ankle pain following an injury typically occurs suddenly and has symptoms including severe pain, swelling, bruising, difficulty putting weight on your ankle, and possibly deformity (your ankle appears misshapen or at a strange angle). 

In some cases, ankle pain can occur without a preceding injury. This type of ankle pain usually starts more gradually than ankle pain due to injury and may have several causes including ankle osteoarthritis, rheumatoid arthritis, gout, and systemic lupus erythematosus (SLE).

Ankle osteoarthritis

Osteoarthritis (OA) is the most common type of arthritis (inflammation of the joints), and it can affect any of your joints including your ankle. Osteoarthritis is caused by wear and tear on your joints and is more common in older adults. It occurs when the protective cartilage in your joint breaks down and bone rubs against bone causing pain, swelling and stiffness. You may have a higher risk of developing ankle osteoarthritis if you are overweight or have a previous ankle injury.

Common symptoms of ankle osteoarthritis may include:

• Painful or aching ankles
• Stiffness in your ankles, which is often worse in the morning or after periods of immobility
• Difficulty moving your ankle joint or reduced range of motion
• Instability, or looseness in your ankle joint

Rheumatoid arthritis

Rheumatoid arthritis (RA) is an autoimmune disease where your body’s immune system mistakenly attacks its own tissues. In the case of RA, this causes inflammation throughout the body including the lining of your joints. It most commonly affects the small bones of your hands and feet, but can also affect your wrists, knees and ankles. Symptoms typically get worse for a period of time, known as a ‘flare-up’, and then improve (remission).

Common symptoms of rheumatoid arthritis may include:

• Joint pain, stiffness and swelling on both sides of your body
• Fever 
• Fatigue 
• Weakness

Gout

Gout is a type of arthritis that is caused by high levels of uric acid in your blood (hyperuricaemia). It causes pain in your joints, normally your big toe, but can also affect your ankle. Symptoms of gout often start suddenly and last for several days or weeks — this is known as a flare-up. You may also have periods without any symptoms.

Common symptoms of gout include:

• Severe pain in a joint that often starts at night
• Redness, swelling and heat around the affected joint

Systemic lupus erythematosus (SLE)

Systemic lupus erythematosus is an autoimmune disease that causes inflammation throughout your body and can lead to a range of symptoms including ankle pain.  People with SLE often experience flare-ups of their condition followed by periods of remission.

Common symptoms of SLE include:

• Pain, tenderness, swelling and stiffness in the joints (including the ankle joint) 
• Fatigue
• Fever
• Rash or photosensitivity (sensitivity to sunlight)

Fallen arches (flat feet) 

This is a common condition where the arch in your foot is low or non-existent and the sole of your foot presses flat to the ground. It doesn’t always cause problems, but for some people can lead to difficult symptoms including pain in your feet and ankles.

Common symptoms of flat feet may include:

• Ankle pain
• Foot pain, including pain in the arch of your foot and heel
• Swelling 
• Changes in your gait (how you walk) 
• Pain in your knees and hips 
• Stiffness 
• Tiredness in your legs and feet after standing for a long time 
• Difficulty performing some movements such as standing on your tiptoes

Achilles tendonitis

Achilles tendonitis is a common condition that occurs when your Achilles tendon (a large tendon that connects your calf muscle to your heel bone) becomes inflamed. It often occurs due to overuse and repetitive movements such as running or jumping. Achilles tendonitis can also be caused or exacerbated by wearing high heeled shoes.

Common symptoms of Achilles tendonitis include:

• Pain, stiffness, tenderness and swelling along your heel and the back of your calf
• Pain is often worse during activity or after a period of rest 
• Weakness and reduced movement in your foot or ankle

Bursitis

Bursitis is inflammation of the fluid-filled sacs (known as bursae) that cushion your joints and act as shock absorbers. Bursitis is most common in the shoulders, elbows, knees, hips, and feet, but it can occur in any joint including the ankles.

Common symptoms of bursitis include:

• Pain and tenderness around your ankle, especially when standing, walking or moving your foot
• Swelling 
• Stiffness
• Difficulty moving your ankle 
• Redness or heat 

When to see a doctor for ankle pain

Ankle pain often gets better on its own or with home treatments such as the RICE protocol (see below). In some cases, ankle pain may be a sign of an underlying condition and may need medical treatment.

Make an appointment with your GP if:

• Your ankle pain is stopping you from doing normal daily activities
• Your ankle pain is getting worse or hasn’t improved after a couple of weeks
• You have numbness, tingling or a change of sensation in your foot
• You have diabetes, peripheral neuropathy, peripheral vascular disease or any other conditions that can affect your feet 

Seek immediate medical attention for ankle pain if:

• Your ankle pain is severe
• You are unable to walk
• You injured your ankle and heard a snapping, popping or grinding sound at the time of your injury
• Your ankle or foot appears deformed or out of shape

How is ankle pain diagnosed?

Ankle pain should only be diagnosed by a healthcare professional. This might be your GP, or you may need to see a consultant such as a specialist orthopaedic surgeon, a doctor specialising in conditions affecting the bones, joints, muscles, ligaments and tendons. To find the cause of your ankle pain, your doctor will start by asking you some questions about your symptoms, general health and medical history. They will examine your ankle for any visible abnormalities, and areas of pain or tenderness. They may ask you to stand or walk.

Sometimes, your doctor may order tests or scans to confirm your diagnosis. These may include a blood test to check your general health, and imaging scans such as an X-ray, CT scan or MRI. 

How to treat ankle pain

Treating your ankle pain depends on the cause. Your doctor may recommend treating your ankle pain at home for a week or two to see if it improves.

Other treatments for ankle pain include:

Medication

Your consultant may recommend over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen or ibuprofen to help reduce inflammation and swelling and relieve pain. If your pain doesn’t improve with over-the-counter medicines, you may be offered a stronger, prescription painkiller, or an injection of corticosteroids into your ankle joint. Corticosteroids are powerful anti-inflammatories that reduce pain and swelling, often for several weeks or months.

If you are diagnosed with a medical condition such as gout or rheumatoid arthritis, your consultant will prescribe medication to treat that condition.

Orthotics

Orthotics are devices that help support your feet and ankles and correct any deformities. They can be bought over the counter or custom-made for you. Orthotics can help with ankle problems such as ankle arthritis or flat feet.

Casting or splinting

A splint or a cast works by immobilising your ankle and holding it in place while it heals. A splint is more flexible and adjustable and is normally used for sprains or strains whereas a cast provides more rigid immobilisation and is used for more severe injuries like a fracture.

Physiotherapy

Ankle physiotherapy is a highly effective treatment that can help improve strength, flexibility and range of motion in your ankle. It can help with several ankle conditions including muscle sprains and strains, Achilles tendonitis and arthritis. Ankle physiotherapy may involve exercises to strengthen your ankle and techniques such as muscle and joint manipulation or electrotherapy.

Ankle joint aspiration (ankle arthrocentesis)

This is a procedure to remove excessive fluid from your ankle joint with a needle and syringe. It can be used to relieve pain and swelling or to diagnose a joint problem by sending the fluid to a laboratory for analysis.

Surgery

In some cases, your consultant may recommend surgery to repair damage to a ligament, fix a more complex fracture or treat severe arthritis. Most ankle surgery can be performed with a minimally invasive (keyhole) technique called an ankle arthroscopy. An arthroscopy can also be used to examine your ankle joint and diagnose any problems. Other types of ankle surgery include ankle fusion (arthrodesis), ankle replacement surgery (arthroplasty), and surgery to repair torn ligaments or tendons.  

How to ease ankle pain at home

Mild ankle pain can often be treated at home by following the RICE protocol. This involves:

• Rest: Rest your ankle as much as possible and avoid activities that trigger or worsen your ankle pain 
• Ice packs: Apply an ice pack wrapped in a towel or cloth (or a bag of frozen peas) to your ankle for 15 to 20 minutes every two to three hours to help reduce swelling
• Compression: A compression bandage around your ankle can help support your joint while it heals
• Elevation: Raise your ankle above the level of your heart while resting to reduce swelling

Some other things you can do to help with ankle pain include:

• Take over-the-counter painkillers like paracetamol or ibuprofen or apply a non-steroidal anti-inflammatory gel to your affected ankle 
• Wear comfortable shoes that support your ankles and feet 
• Avoid shoes that don’t fit properly, high heels and shoes with pointy toes 
• Use insoles or foot pads inside your shoes 
• Try gentle stretching exercises (see below)

Ankle pain exercises

Ankle exercises can help with ankle pain, increase strength in your ankle joint and improve flexibility and range of motion. Always talk to your doctor or physiotherapist before starting exercises for ankle pain. Start slowly and build up the amount of exercise you do gradually. Stop if you feel pain.

You can see some ankle exercises from the NHS and Versus Arthritis here:

• Exercises for ankle pain 
• Exercises for the toes, feet, and ankles 

Ankle pain FAQs

We answer some of your most frequently asked questions about ankle pain.

Is it okay to walk with ankle pain?

Whether or not you should walk with ankle pain depends on your diagnosis, treatment and your doctor’s advice. During your recovery, light walking can be beneficial and will help strengthen your ankle muscles, maintain flexibility and aid healing by improving your circulation. Always follow your consultant or physiotherapist’s advice, start slowly, build up your activity level gradually, avoid any activities that make your ankle pain worse and stop if you feel pain.

Can driving cause ankle pain?

Driving can cause pain and stiffness in your ankle or foot, especially if you have a pre-existing problem such as arthritis, plantar fasciitis or Achilles tendonitis. Sitting with your foot on the brake, clutch or accelerator for prolonged periods can put strain on your ankle joints leading to pain. To avoid ankle pain while driving, take your feet off the pedals and put the car into neutral with the handbrake on while motionless. It can also help to make sure your seat is in the correct position, and you are not too close or too far from the pedals.

How can I prevent ankle pain when running?

Your ankles take a lot of the strain when running, and ankle problems among runners are common. To help prevent ankle pain when running:

• Wear the correct shoes that fit properly, provide adequate support to your arches and cushion the soles of your feet
• Warm up properly before running 
• Ensure the correct form: Keeping your ankles relaxed while running and landing on your midfoot, not your heel, helps absorb impact and reduces the strain on your ankles
• Perform ankle exercises to strengthen your ankle muscles and improve stability in your ankle joint 
• Build up your activity level gradually and give your body time to adjust to any new activity
• Avoid running on uneven or rough surfaces 
• Wear ankle braces to support and protect your ankle, especially if you have a history of ankle problems 
• Stop if you feel pain or discomfort in your ankles 

Ankle pain in summary

Ankle pain is common and has a variety of possible causes. At Circle Health Group, our network of experienced orthopaedic consultants are experts in diagnosing ankle problems and offer a wide range of treatment options tailored to your needs. Make an appointment with a specialist today, get access to a rapid diagnosis and treatment and get back to doing the activities you enjoy! 

Clinical sources and further reading

1. Ankle pain, NHS
2. Ankle problems, NHS Inform 
3. Foot and Ankle Pain, Versus Arthritis