March 5, 2021

The human body is incredibly complex. It is made up of several different systems and every bone, joint, and tendon work together to keep you moving. However, certain areas can eventually cause pain and problems. This article will discuss sources of ankle pain. Ankle pain is a fairly common source of pain and injury. Overuse can cause wear and tear leading to pain, swelling, tightness or stiffness of the joint. Whether it is tenderness from a recent ankle injury or chronic pain there are ways to lower your ankle pain and bring relief.  The key to seeking care is to understand the mechanism of your injury. This can help determine the source of you discomfort and treatment options.  Let’s dive into some common causes.


Your ankle is complex.

The ankle is an incredibly complex joint. There are multiple things to consider when analyzing ankle pain such as tendons, soft tissue, bones and cartilage. As a hinge joint, your ankle undergoes dorsiflexion and plantarflexion motions. Your ligaments and muscles work together to move your foot and ankle and support the weight of your body. Because of these different movements and systems, common injuries can occur.

What pain might you experience?

Ankle pain may present differently in everyone. Maybe you simply rolled your ankle while out for a morning jog or maybe you’re dealing with a stress fracture or osteoarthritis. Be on the lookout for ankle swelling, difficulty walking, throbbing, sharp pain, general aches, redness or soreness. These symptoms are signs that your ankle should be evaluated.


Sprains or Fractures

Sprains and fractures can prevent you from walking. A fracture occurs when there is physical impairment to the bony structure or a break. There are different severities of a fracture. A stress fracture is a tiny crack in a bone versus a complete break in the bony integrity. Physicians use imaging such as X-rays, MRIs and CTs to evaluate for fractures. Most commonly an X-ray will be used. Physicians follow certain guidelines to determine if an X-ray is needed. The fracture type, for example a stress fracture or a more serious fracture, will determine the treatment. Treatment can vary from rest, ice, and elevation to a simple cast or surgery for more serious injuries. Ankle sprains do not involve the bone but the ligaments that hold the joint in place. Sprains can occur with falls, overuse from activity, or walking on uneven surfaces. Lateral ankle sprains are most common and make up 14% of all sports related injuries. More than 80% of sprains are due to inversion mechanism. Sprains are separated into different grades.

Grade 1: simple stretch or partial tear of the ligament without laxity.

Grade 2: partial tear of ligament with increased laxity.

Grade 3: rupture of ligament leading to gross laxity.



Another cause of chronic ankle pain is arthritis. There are two forms of arthritis; rheumatoid and osteoarthritis. Osteoarthritis is caused by wear and tear of cartilage between your bones which leads to pain. The fluid and cushion structure has worn away causing pain during weight-bearing activities, such as walking. Rheumatoid arthritis is caused by the immune system attacking the joint. This can cause pain and ankle instability. It may require medications that treat the immune system as opposed to the joint directly.


Your tendons are what connect your muscles to your bones. You may experience tendonitis in your injured ankle caused by swelling or irritation of your tendons. Peroneal tendonitis is specific to your ankle tendons that run on the outside of your leg and ankle. When these connective tissues on the outside or inside of the ankle get inflamed, it can cause serious injury or severe pain.


Flat Feet or Harmful Walking Habits

Foot shape, improper shoes, and your physique can affect ankle pain. It may be hard to admit, but you may be experiencing ankle pain because of your foot shape and your walking habits. For individuals with flat feet, your ankles are working overtime to align with your knees and help you walk effectively. Without a natural arch in your foot, you may be putting repetitive stress on your ankle. Likewise, individuals who run, walk, or do a lot of physical activity and are experiencing pain or discomfort should reevaluate how they’re walking. The first thing to look at is your footwear to see if your Achilles and ankles are being supported and the bottom of the foot is in a proper arch. A podiatrist can look at your gait and help you understand the proper treatment and ways to improve your arch support so you can decrease your ankle pain.

Less Common Causes

While ankle pain is fairly common and treatable, there is a chance your ankle condition is a rarer issue. Check with your health care provider to see your risk factors for any of these less common causes of ankle pain.


Gout is a specific form of arthritis that commonly occurs in your big toe and can cause foot pain. It is caused by uric acid build-up that forms crystals in your joints. The area involved presents as a sudden, painful, red, and hot joint. It can mimic an infection therefore it should be evaluated by a medical professional.



Difficulty with ankle movement or chronic ankle instability may be a result of a bone infection. Ankle infection is rare, but if you are experiencing warmth, skin breakdown, and irritation in your ankle it may be due to an infection. Seek medical treatment as this requires imaging to diagnose and antibiotic treatment for recovery. Those with untreated diabetes and wounds are at high risk for bone infection.

Seeking Medical Help

Sometimes an ankle injury can be mild. If you have twisted your ankle from running, dancing or another small injury you may not need to seek immediate medical care as these injuries can improve with rest, ice, elevation, and anti-inflammatory medications. However when experiencing severe discomfort, pain lasting longer than usual, inability to walk, or difficulty bending your ankle, your symptoms warrant medical attention.

Treatment Options

Depending on your diagnosis, your proper healing will look different. Simple RICE protocol (Rest, Ice, Compression, and Elevation) may be therapeutic. Icing your ankle for a ten minutes three to four times per day with elevation can help reduce swelling and pain. You may consider wrapping an unstable ankle with a brace or splint to help with muscle strains until your ankle is evaluated by a medical professional.

A more severe injury may warrant further imaging, such as an X-ray, and physical therapy. For some injuries, physical therapy can improve mobility and strengthen joints for faster healing. Other injuries may be more severe and require surgical treatment. Medical care may be the best course of action when you are unsure or your pain is severe.


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