Mainly ankle pain is caused by sprains/strains. Other ankle pain causes are arthritis, gout or infections. Below we review major ankle pain causes and also touch on what causes severe ankle pain. Then we will discuss relief options and answers to FAQs.
Hallmarks of ankle pain and duration
You love your morning jogs. Watching the sun rise as the wind blows through your hair seems to center you for the day. But one day, your foot lands strangely, slips out from under you, and you're stuck on the sidewalk with an ankle that's just not right.
Are you rankled by ankle pain symptoms? Ankle pain can be felt on the inner side of the ankle, on the outer area, in line with the Achilles tendon, and sometimes radiating near the upper part of the foot.
Common characteristics and accompanying symptoms of ankle pain
If you're experiencing ankle pain, it is also likely to experience:
- Burning pain in the ankle: While walking, jogging, and running
- Swelling of the ankle
- Numbness or tingling sensation
- Inability to bear weight on the ankle
Severe ankle pain
Severe ankle pain can usually be described by the following details.
- Pain: Sudden, severe pain that makes it all but impossible to walk.
- Obvious deformity: The ankle appears crooked or misshapen, or there may be bone protruding through the skin.
- Ankle bruising
- Ankle redness and heat
The ankle is a tricky little thing. It also bears plenty of your body's weight. Its health and ability to function are crucial to everyday activities and comfort.
The ankle is an important joint, connecting the lower leg bones to the foot bones. It is divided into the lower ankle and upper ankle. The lower ankle allows your foot to tilt to the side and turn outwards and inwards. The upper ankle lets you move your feet up and down.
Whether you injure the joint, a bone, the upper ankle, or the lower, the associated pain can literally stop you in your tracks. Most causes of ankle pain are treatable though. With a little time, you can be back to your normal activities.
Duration of symptoms
The duration of your ankle pain may vary depending on the cause.
- Acute: Severe ankle pain almost always starts suddenly, usually as the result of an injury.
- Chronic: A chronic ankle condition can become acute if the disease causing it worsens, or there is wear-and-tear after an old injury and the damage suddenly gives way.
Who is most often affected?
People most likely to experience severe ankle pain include the following:
- Men under age 30
- Women over age 30: Especially those who wear high heels
- Anyone playing sports
Is severe ankle pain serious?
Ankle pain that is described as severe will likely require a consult with your physician if it persists.
- Not serious: The pain subsides quickly after the injury and any swelling responds to rest, ice, and over-the-counter non-steroidal anti-inflammatory drugs.
- Moderately serious: The pain continues for a few days, even without signs of fracture or infection.
- Serious: If there is pain along with an obvious injury or deformity, and/or redness and swelling in the ankle, this is a medical emergency.
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9 ankle pain causes
Causes of ankle pain can be broken down into two main categories -- injuries or trauma and medical conditions, including infection. Listed below are the most common ankle pain causes.
Injury or trauma-related ankle pain causes
Ankle pain may be due to trauma or injury to the area.
- Sprains, strains, and fractures: These are the most commonly reported causes of ankle pain. Any of these can happen if one suddenly changes his or her position when moving. Accidents can likewise be a culprit. Falling or colliding with another individual or objects can injure your ankle. Athletes are more prone to this cause.
- Achilles tendon rupture: The Achilles tendon attaches the calf muscle to the heel bone, known as the calcaneus. If this tendon ruptures tears loose from the bone, it will cause severe pain, swelling, and achilles swelling and bruising in the ankle.
Additional causes for severe ankle pain
Injuries to the ankle due to various fractures, sprains, or Achilles tendon ruptures can cause severe ankle pain. Ankle injuries are is among the most common reasons people visit the emergency room.
- Avulsion fracture: A ligament or tendon tears away from its attachment on the bone, taking a fragment of bone with it.
- Fibula fracture: The fibula is the smaller of the two bones in the lower leg. A break just above the ankle can cause severe ankle pain.
- Stress fracture: This is a crack or severe bruising in the small bones of the ankle, due to overuse and/or weakening from a loss of minerals.
Medical ankle pain causes
Medical conditions or other illnesses may result in ankle pain, such as the following.
- Rheumatoid arthritis: This chronic inflammatory and autoimmune disease of the joints commonly affects the ankle. The immune system attacks the synovium, which acts as a protective membrane lining the joints. This causes severe inflammation and pain.
- Gout: An increased uric acid level in the body will cause a deposition of crystals in the joint. This is very painful.
- Infection: Bacterial joint inflammation is a serious condition and causes severe pain in the ankle joint. This is often referred to as septic arthritis. Bacteria gets into the joint and causes severe cartilage destruction and bone damage. If not treated, it can lead to septic shock.
Other severe ankle pain causes
Other conditions can eventually lead to severe ankle pain.
- Ankle impingement: This involves a bony growth at the front of the ankle bone where it meets the shinbone. It restricts the ankle's range of motion and causes pain.
- Metabolic disorders: This may involve a buildup of mineral crystals within the joints, often in the big toe or the ankle. This causes intense pain and some swelling. The buildup may be caused by either uric acid crystals in people with gout or calcium pyrophosphate dihydrate crystals in those with pseudogout.
Rare and unusual ankle pain causes
Rare and unusual causes that may lead to severe ankle pain include:
- Loss of blood supply to the bone: This can follow trauma, blood vessel blockage, or certain diseases, and causes bone damage and pain.
- Tumors: These can form in and around the ankle joint, causing pain and swelling.
Whether you're incredibly active or spend most nights on the couch, an ankle injury can happen to anyone. If you find yourself with an ankle that's not cooperating, it's time to look into treatments.
Arthritis simply means inflammation of the joints. Because the feet and ankles have many small joints and carry the weight of the body, they are often the first place that arthritis appears.
Arthritis is caused by a breakdown in the protective cartilage at the end of each joint, so that the bones begin to wear against each other and the joint becomes stiff and painful. This breakdown may be due to simple wear and tear; an injury; or from rheumatoid arthritis, an autoimmune condition which causes the body to break down its own cartilage.
Symptoms include swelling, warmth, and redness in the joint, and pain with movement or with pressure on the joint.
Diagnosis is made through patient history, physical examination, and imaging such as x-rays, CT scan, or MRI.
There is no cure for arthritis, but treatment is important because the symptoms can be managed to prevent further damage, ease pain, and improve quality of life. Treatment involves physical therapy, pain-relieving medications, and sometimes surgery to help repair damaged joints.
Top Symptoms: swollen ankle, swollen foot, joint stiffness, pain in one ankle, ankle stiffness
An ankle fracture is a break in 1 or more ankle bones.
Top Symptoms: difficulty walking, constant ankle pain, swollen ankle, pain in one ankle, ankle pain from an injury
Symptoms that always occur with broken ankle: pain in one ankle, swollen ankle, ankle pain from an injury, constant ankle pain
Urgency: Hospital emergency room
Ankle ligaments, which connect bones to one another, stabilize the ankle joint. A sprain is an injury to the ligaments caused by a twisting motion of the joint.
Top Symptoms: pain in one ankle, ankle pain from an injury, swollen ankle, bruised ankle, ankle twisting
Symptoms that always occur with ankle sprain: pain in one ankle, ankle pain from an injury
Urgency: Phone call or in-person visit
Fibromyalgia is a set of chronic symptoms that include ongoing fatigue, diffuse tenderness to touch, musculoskeletal pain, and usually some degree of depression.
The cause is not known. When fibromyalgia appears, it is usually after a stressful physical or emotional event such as an automobile accident or a divorce. It may include a genetic component where the person experiences normal sensation as pain.
Almost 90% of fibromyalgia sufferers are women. Anyone with rheumatic disease, such as rheumatoid arthritis or lupus, may be more prone to fibromyalgia.
Poor sleep is often a symptom, along with foggy thinking, headaches, painful menstrual periods, and increased sensitivity to heat, cold, bright lights, and loud noises.
There is no standard test for fibromyalgia. The diagnosis is usually made when the above symptoms go on for three months or more with no apparent cause.
Fibromyalgia does not go away on its own but does not get worse, either.
Top Symptoms: fatigue, arthralgias or myalgias, anxiety, depressed mood, headache
Symptoms that always occur with fibromyalgia: arthralgias or myalgias
Urgency: Primary care doctor
Osteochondritis dissecans, also called OCD, is a joint condition. It occurs when there is not enough blood flow within the end of a bone, under the protective cartilage. These bone layers begin to die and separate from the main bone, taking the cartilage with them.
The exact cause is not known. It may be due to overtraining a young person before the bone is entirely mature, which can interfere with blood supply.
Most susceptible are children and teenagers. The condition is found most often in only one joint, usually the ankle, knee, or elbow. However, any joint can be affected and there may be more than one.
Symptoms include swelling and pain in the joint during exercise, and sometimes "locking" of the joint. Osteochondritis dissecans may lead to osteoarthritis if not treated.
Diagnosis is made through patient history, physical examination, and imaging.
Treatment first involves rest because in children who are still growing, the bone and cartilage may heal spontaneously. If there are loose pieces of bone within a joint, surgery may be necessary.
Top Symptoms: pain in one knee, knee stiffness, knee instability, knee pain that gets worse during a run, pop in the knee
Urgency: Primary care doctor
Posterior tibialis tendinopathy
The posterior tibialis tendon attaches the calf muscle to the bones on the underside of the foot. It provides stability and arch support. If this tendon is damaged, the result may be a flat, unstable foot.
Posterior tibialis tendinopathy is most often a sports injury, where the tendon becomes inflamed or torn through overuse or high impact.
Symptoms include pain down the ankle and into the foot, sometimes with swelling. The pain becomes worse with any activity, even standing or walking. When standing, the patient's arch will be collapsed and flat and the front of the foot will point outward. The patient will be unable to stand on the injured foot and raise the heel.
Diagnosis is made through patient history, physical examination, and imaging such as x-ray, CT scan, or MRI.
Treatment involves rest, over-the-counter pain relievers, orthotics (shoe pads,) braces, and sometimes steroid injections into the damaged tendon. Surgery can be tried, but tends to be complex and cannot always restore the tendon completely.
Rarity: Ultra rare
Top Symptoms: swollen foot, pain in one foot, limping, pain in one ankle, spontaneous ankle pain
Symptoms that never occur with posterior tibialis tendinopathy: recent cutting accident
Urgency: Primary care doctor
A bruise is the damage of the blood vessels that return blood to the heart (the capillaries and veins), which causes pooling of the blood. This explains the blue/purple color of most bruises. Bruises of the ankle are common, often due to minor injury.
Top Symptoms: constant ankle pain, pain in one ankle, ankle pain from an injury, recent ankle injury, swollen ankle
Symptoms that always occur with ankle bruise: ankle pain from an injury, recent ankle injury, constant ankle pain
Gout is a form of arthritis that causes sudden pain, stiffness, and swelling in a joint. The big toe is often affected.
Top Symptoms: swollen toes
Urgency: Primary care doctor
Cellulitis is a bacterial infection of the deep layers of the skin. It can appear anywhere on the body but is most common on the feet, lower legs, and face.
The condition can develop if Staphylococcus bacteria enter broken skin through a cut, scrape, or existing skin infection such as impetigo or eczema.
Most susceptible are those with a weakened immune system, as from corticosteroids or chemotherapy, or with impaired circulation from diabetes or any vascular disease.
Symptoms arise somewhat gradually and include sore, reddened skin.
If not treated, the infection can become severe, form pus, and destroy the tissue around it. In rare cases, the infection can cause blood poisoning or meningitis.
Symptom of severe pain, fever, cold sweats, and fast heartbeat should be seen immediately by a medical provider.
Diagnosis is made through physical examination.
Treatment consists of antibiotics, keeping the wound clean, and sometimes surgery to remove any dead tissue. Cellulitis often recurs, so it is important to treat any underlying conditions and improve the immune system with rest and good nutrition.
Top Symptoms: fever, chills, facial redness, swollen face, face pain
Symptoms that always occur with cellulitis: facial redness, area of skin redness
Urgency: Primary care doctor
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Ankle pain relief and prevention
When to see a doctor for ankle pain
See a doctor if you're experiencing any of the following:
- Severe swelling
- Intense pain
- Open wounds
- Noticeable deformity
- Signs of infection
- Unable to put weight on affected foot
When managing ankle pain symptoms, consider both treatments and preventive measures. Both can help ease your pain.
At-home ankle pain treatments
You can begin addressing your ankle pain symptoms at home while you recover or wait for an appointment.
- RICE Method: If the pain is due to an injury, provide first aid to control the swelling and pain. Rest the ankle. Put ice on for about 20 minutes and repeat three times daily. Compress the ankle, but not too tightly, by putting on an elastic bandage. Elevate the ankle above the heart level.
- Medications: Ankle pain can be treated with non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, analgesics, and other OTC pain relievers.
- Devices: Crutches and walkers are helpful for mobility and rest.
- Therapy: Exercises facilitated by a physical therapist can help restore the ankle's strength and flexibility.
- Surgery: In severe cases, surgery can be necessary for the reconstruction of damaged ligaments and fractured bones.
Preventive measures for ankle pain
Try the following methods to help prevent ankle pain and injury.
- Watch your step closely when walking, particularly on uneven surfaces
- Warm up before doing any strenuous exercises or sports
- Avoid wearing high-heeled shoes
- Exercise and stretch regularly
- Watch your weight
- Eat a balanced diet
Free yourself from ankle pain by knowing its symptoms, causes, and treatment. You'll be back on two healthy feet in no time.
FAQs about ankle pain
Can bunions cause ankle pain?
Generally, bunions do not cause ankle pain. A bunion is a deformity of the big toe in which the toe is deformed outward and the joint protrudes inward. Studies have been performed on whether bunions are associated with any particular injury of the foot. While some authors have drawn those conclusions, it has not been conclusively proven. It is possible, however, that bunions affect balance which may lead to falls in the elderly.
What causes ankle pain without swelling?
Ankle pain without swelling can be caused by a stress fracture of an ankle bone or partial ligament tear causing instability of the ankle. Swelling is caused by traumatic damage to the cells of tissue within the body. As the contents of the cells spill out, they can cause the body to send in immune cells to clean and repair the wound. This requires swelling to "make space" for the immune cells.
Why would someone experience ankle pain while walking?
Ankle pain while walking may be due to swelling and an increase in inflammation following a mild injury to the ligaments, joints, or bones of the ankle. The most common of these conditions are ankle sprains (partial ruptures of a ligament), arthritis, or inflammation of the tendon (tendinitis).
Will insoles help relieve ankle pain?
This depends on the cause of ankle pain. If ankle pain is caused by an excessive motion of the foot (inversion, eversion, pronation, or supination) then an insole can take stress off the foot and decrease repetitive stress injury. Other causes of ankle pain include ankle fractures or sprains and plantar fasciitis . Ankle fractures need medical evaluation and stabilization to ensure strong healing. Plantar fasciitis is worsened by a flat shoe but can be improved significantly by stretching, avoiding flat shoes or barefoot walking, and silicone insoles.
Can ankle pain be related to back pain?
Yes, ankle, knee, and hip pain can all contribute independently to back pain. Each of the joints is designed to direct the force of gravity to another point on the next joint that is designed to bear the pressure. If one of the joints is out of alignment, the entire structure of bones and cartilage can suffer increased wear and tear causing pain in the hips or back.
How can I have sudden, severe ankle pain if I didn't have an injury?
Ankle joints are vulnerable to both illness and injury. Arthritis, which is the destruction of the cartilage that cushions the ends of the bones, can be very damaging and cause pain that goes from dull to severe very quickly as the wear progresses. Gout, which is the buildup of mineral crystals within the joints, also causes intense pain.
Does an ankle fracture cause permanent damage?
This depends on how many of the bones in the ankle are involved, as well as how many ligaments are sprained or ruptured (torn). Surgery may be needed. Allow at least six to eight weeks for bones and ligaments to heal, followed by as long as a year to finish rehabilitation. With good care, most people recover very well.
Can a lower leg injury cause severe ankle pain?
Yes. If the fibula, the smaller of the two bones in the lower leg, is fractured down low, the pain will be felt largely in the ankle. The Achilles tendon connects the calf muscle to the heel bone or calcaneus, and if it ruptures meaning it is torn loose from the heel bone the pain will be intense down into the ankle.
Does a ruptured Achilles tendon always require surgery?
Not always. Surgery is most often done for serious tears in younger and very athletic people, while others can usually be treated non-surgically with rest, non-steroidal anti-inflammatory drugs for pain, a walking cast for support, and rehabilitation therapy. Recovery may take longer without surgery, but can still be accomplished quite well.
Can ankle pain be hereditary?
The pain itself is not, but the conditions that create it can run in families. These include small malformations of the ends of the bones, which predispose the person to arthritis as well as oddly sized feet or one leg longer than the other. Inherited defects in the immune system can lead to autoimmune illnesses that cause arthritis and joint pain.
Questions your doctor may ask about ankle pain
- How would you explain your ankle pain?
- Have you ever been diagnosed with diabetes?
- What is your body mass?
- Any fever today or during the last week?
Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.
- Arthritis and Diseases that Affect the Ankle. Arthritis Foundation. Arthritis Foundation
- Achilles Tendon Rupture (Tear). OrthoInfo. Published May 2012. OrthoInfo Link
- Weatherford BM. Rheumatoid Arthritis of the Foot and Ankle. American Academy of Orthopaedic Surgeons: OrthoInfo. Published September 2017. OrthoInfo Link
- Gout. MedlinePlus. Published March, 2016. Medline link
- Haddad SL. Bunions. American Academy of Orthopaedic Surgeons: OrthoInfo. Published February 2016. OrthoInfo Link
- Plantar Fasciitis. American Orthopaedic Foot & Ankle Society. AOFAS Link