Ankle pain

Ankle pain may include symptoms such as:

• Pain or discomfort in your ankle joint - this may be throbbing, burning, or aching. It may start suddenly or get worse over time. You may have pain only when you walk or all the time
• Swelling
• Stiffness
• Difficulty walking
• Reduced movement of the ankle joint

The ankle is a complex joint made up of bones, cartilage, ligaments, tendons, and muscles. Injury to any of these structures can cause ankle pain. Alternatively, ankle pain can be caused by an underlying medical condition such as arthritis.

Some common causes of ankle pain include:

Sprains

A sprain occurs when there is damage to a ligament (the tough fibrous tissue that connects bone to bone). Sprains commonly occur through twisting your joint suddenly, such as when you land awkwardly during a fall, or sudden movements during sport. Symptoms include pain, swelling, and bruising of the ankle joint.

Tendonitis

This is inflammation of your tendons (the connective tissue that connects muscle to bone). There are three types of tendonitis that affect your ankle joint.

• Peroneal tendonitis is inflammation of the tendons on the outside of your ankle. It often develops slowly over several weeks and gets better with rest. Symptoms include a dull ache, tightness and sometimes swelling on the outside of your ankle.
• Posterior tibial tendonitis causes pain and swelling on the inside of your ankle joint. It often comes on slowly and is caused by repetitive stress or a series of minor injuries to your tendon. It may cause deformity and difficulty walking if left untreated
• Achilles tendonitis affects the tendon at the back of your ankle. Symptoms include burning, pain, tightness, swelling, and morning stiffness that may affect your heel and calf.

Bursitis

Bursae are small fluid-filled sacs that cushion the bones, muscles, and tendons in your joints. When these sacs become inflamed, it causes a condition called bursitis. Symptoms of ankle bursitis include pain, swelling, and redness around the heel. It may also be difficult to put weight on the affected foot.

Arthritis

There are four types of arthritis that may cause ankle pain.

• Osteoarthritis occurs when the cartilage in your joint deteriorates due to wear and tear, causing your bones to rub against each other. It often starts as a dull pain in your joints that gets worse over time
• Rheumatoid arthritis (RA) is an autoimmune disease that occurs when your immune system mistakenly attacks its own tissues. In the case of RA, this includes the muscles and joints. Symptoms include warm, painful, swollen joints, stiffness, fatigue, loss of appetite, and low fever
• Reactive arthritis is a type of inflammatory arthritis that can occur after an infection. It causes redness, stiffness, and swelling of one or more joints. Reactive arthritis normally clears up by itself within a few months, though occasionally it can be a chronic (long-term) condition
• Post-traumatic arthritis occurs after an injury to a joint. It is like osteoarthritis in that it causes the cartilage to wear away, but the condition develops quickly after an injury and normally goes away without treatment after a few months

Fractures

A fracture is a break in a bone. In the ankle, this may be the bones of the lower leg (tibia or fibula) or the foot bone (talus). Ankle fractures are commonly caused by trauma such as tripping, falling, or a car accident. Symptoms include sudden severe pain, bruising, swelling, deformity, and inability to put weight on your affected ankle.

Bone bruises (bone contusions or bone marrow oedema)

Like fractures, bone bruises are normally caused by trauma or repetitive overuse. They have similar symptoms to fractures but are less severe and occur when there is damage to the surface of the bone. Symptoms include pain, swelling, stiffness, and difficulty moving the affected joint.

Some rare causes of ankle pain include:

Gout

Gout is a type of inflammatory arthritis that normally affects your big toe joint, but in rare cases may affect your ankle. It occurs when you have high levels of a chemical called uric acid in your body. Symptoms of gout include pain, swelling, redness, heat, and reduced mobility in the affected joint,

Tarsal tunnel syndrome

Tarsal tunnel syndrome or posterior tibial neuralgia occurs when one of the nerves that supply your legs becomes compressed in an area called the tarsal tunnel. It is similar to carpal tunnel syndrome which occurs in the wrist. Symptoms include shooting pain, burning, tingling, and numbness.

Infection in your bone (osteomyelitis)

Bone infections occur when bacteria enter the bones through the bloodstream, or via a wound after injury or surgery. Symptoms include fever, swelling, warmth, redness, pain, and fatigue.

Peroneal neuropathy

This occurs when the peroneal nerve that runs down your leg is compressed. Symptoms vary depending on where the compression occurs but include numbness, tingling, pain, weakness, and in severe cases, foot drop (where you are unable to flex the foot upwards).

Tumours

Bone tumours are normally benign (non-cancerous) but may need treatment as they can grow and cause problems with your healthy bones. Malignant (cancerous) bone tumours are rare but need immediate treatment as they can spread to other parts of your body. Symptoms of bone tumours include a dull ache that gets worse or more constant over time. You may develop a lump somewhere on your body, or your bones could become weaker and break more easily. Other symptoms may include fever and night sweats.

At Circle Health Group, your first appointment will be with a consultant orthopaedic surgeon, a doctor who specialises in problems with your bones, joints, muscles, tendons, and ligaments.

Your consultant will ask you some questions about your symptoms, including what they are, how long you have had them, and how they started.

Your consultant will examine your ankle for signs of redness, swelling, visible injury, or deformity. They may apply firm pressure to your ankle to check for areas of pain or tenderness and check how well you can move your ankle.

You might need tests or scans

Your consultant may be able to make a diagnosis based on your symptoms and physical examination, but normally they will need tests or scans to make or confirm their diagnosis. These may include:

• X-ray - to look for any problems with your bones
• Computerised tomography (CT) - to examine your joint in more detail
• Magnetic resonance Imaging (MRI) - to examine your soft tissues, nerves, and blood vessels
• Electromyography - to check for problems with your nerves
• Biopsy - to test for infection, or if you have a suspected tumour
• Blood tests - to test for underlying health conditions like gout or rheumatoid arthritis

How will you be diagnosed?

Your consultant will make a diagnosis based on your symptoms, physical examination, and test results.

Why is your first consultation so important?

Your first consultation at Circle Health Group is important because it's where you first meet your consultant, explain your symptoms, receive a diagnosis, and discuss possible treatment options.

It's also where we get to know you, discuss any concerns you have, answer your questions, and learn about your expectations for treatment. It's very important to us that you are as comfortable and well-informed as possible, so please ask your consultant any questions you may have during your first consultation.

The treatment for ankle pain depends on the cause. After your consultant has made a diagnosis, they will discuss treatment options with you. These may include:

• Treating your ankle pain yourself at home
• Orthotics such as a brace or shoe insoles
• Physiotherapy
• Medications such as non-steroidal anti-inflammatory drugs (NSAIDs)
• Steroid injections
• Surgery such as arthroscopy, or total ankle replacement

Some ankle problems can be treated at home using the RICE protocol. This is often the first choice of treatment for ankle pain caused by conditions such as sprains and tendonitis.

The RICE protocol is as follows:

• Rest - rest the joint as much as possible to relieve pain and inflammation
• Ice - apply an ice pack such as a bag of frozen peas wrapped in a cloth to help reduce swelling
• Compression - apply a compression bandage around your ankle to support and immobilise your joint. Make sure your compression bandage is not too tight and doesn't impair blood flow to your foot
• Elevation - raise your ankle on a pillow as much as possible to help reduce swelling.

How long it takes you to recover from ankle pain depends on what is causing the pain. Your consultant will be able to advise you on your recovery from pain and treatment based on your diagnosis, treatment, and individual circumstances. If you have surgery such as ankle arthroscopy to diagnose or treat your ankle pain, full recovery can take up to six weeks.

Regardless of whether you have surgery, or need physiotherapy to help manage your symptoms, you will be guided through each step of your recovery period by your dedicated healthcare team.

We answer some of your commonly asked questions about ankle pain.

Can planter fasciitis cause ankle pain?

Plantar fasciitis is a condition where there is inflammation of the plantar fascia, the ligament that stretches along the bottom of your foot from your heel to your toes. It normally causes pain and swelling in the heel and the arch of the foot but can also cause ankle pain.

Is a sprained ankle painful?

Yes. A sprained ankle is usually painful. Sprained ankles occur when there is damage to the ligaments around your ankle. Ligaments are fibrous bands of tissue that connect bones to bones and help stabilise your joints. How severe the pain is and how long it takes to recover from a sprained ankle depends on how badly your ligaments are damaged.

Can driving cause ankle pain?

Yes. If you experience pain in your feet or ankles while driving, you may have a condition called driver's foot. This is a type of repetitive stress injury caused by spending a lot of time driving or sitting in traffic with your foot on the brake pedal. Conditions such as plantar fasciitis and Achilles tendonitis are also more common in people who spend a lot of time driving.

To help relieve symptoms of driver's foot:

• Make sure your seat is in a position where you can comfortably reach the pedals without being too close
• Wear comfortable shoes and avoid high heels, or shoes with no support like flip flops while driving
• Custom orthotics to support and cushion your feet may help in some cases
• Elevate and apply ice packs to your feet after driving to help reduce swelling

How to get rid of ankle pain

How to get rid of ankle pain depends on the cause. The first step in treating ankle pain is usually the RICE method described above.

See a doctor if:

• Your ankle pain and swelling aren't getting better after using the RICE method for a few days
• Your pain or swelling is severe
• You cannot put weight on your foot
• You have an open wound
• Your ankle is visibly deformed
• Your ankle is red, or hot to the touch
• You have a fever

Can anxiety cause ankle pain?

Long-term stress and anxiety have been linked to chronic pain disorders such as arthritis, fibromyalgia, and lower back pain.

When you are stressed, your body releases hormones that increase your heart rate, create muscle tension, and heighten your sensitivity to pain. Rapid breathing or hyperventilation is another stress response that can lower levels of calcium in your blood leading to muscle spasms, cramps, numbness, and tingling in the hands and feet.

How to prevent ankle pain when running

Ankle pain is common among runners. It may be caused by poor footwear, not stretching adequately before you run, old injuries, or running too much.

To treat and prevent ankle pain from running:

• Try the RICE protocol mentioned above until the pain and swelling subside
• Invest in high-quality running shoes that support your feet and fit correctly
• Maintain a healthy weight
• Always stretch properly before and after a run

At Circle Health Group we have the experience and expertise to ensure the best possible care and outcome for our patients. As a patient with Circle Health Group, you can expect the highest standards of care including:

• Flexible appointment times and locations that are convenient for you
• The freedom to choose which hospital and consultant best suit your needs
• Personalised, consultant-led treatment plans tailored to your individual needs
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private ensuite rooms as standard
• A range of delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to see a consultant or learn more about treatments for ankle pain, book your appointment today or call a member of our team directly on 0141 300 5009.

Content reviewed by Circle in-house team in November 2022. Next review due November 2025.

1. Causes of Ankle Pain and Treatment Options Very Well Health
2. Why your ankle hurts WebMD
3. Ankle problems NHS Inform
4. Ankle pain NHS
5. Diagnosis and treatment of chronic ankle pain PubMed