Severe Ankle Pain Symptoms, Causes & Common Questions

Understand severe ankle pain symptoms, including 6 causes & common questions.

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  1. Symptoms
  2. Causes
  3. 6 Possible Severe Ankle Pain Conditions
  4. Treatments and Relief
  5. Real-Life Stories
  6. FAQs
  7. Questions Your Doctor May Ask
  8. Statistics
  9. Related Articles
  10. References

Severe Ankle Pain Symptoms

The ankle is very complex because it must be both flexible enough to move through a wide range of motion and strong enough to support the entire weight of the body. This means that it is vulnerable to overuse, injury, and certain inflammatory diseases. Any of these factors can result in severe ankle pain.

Common characteristics of severe ankle pain

Severe ankle pain can usually be described by the following details.

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.

Severe Ankle Pain Causes

Many conditions can cause the symptom of severe ankle pain. We've listed several different causes here, in approximate order from most to least common [1-3].

Injury-related causes

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 [1].

  • 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.
  • Sprain: This involves twisting the foot and overstretching or tearing a ligament in the ankle. Sometimes a piece of cartilage or a bone breaks loose at the same time and this foreign body in the joint causes pain and a "locking" sensation [4].
  • 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 bruising in the ankle [5,6].

Infectious causes

If the bone or the soft tissues in the ankle become infected, there will be severe pain with redness, heat, and swelling. This can occur due to a bug bite, wound, or any other other infection the becomes severe and localized to the ankle. This is a medical emergency.


This is described by wearing away of cartilage at the end of a joint, causing pain and sometimes deformity and swelling. The following can contribute to the development of arthritis.

  • Joint inflammation: This is most often due to bacterial infection.
  • Heredity: Certain joint malformations that lead to arthritis can be passed down in families.
  • Autoimmune disease
  • Being overweight or obese
  • Injuries
  • Overuse

Other conditions

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 [3].

Rare and unusual 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.

We've listed some specific conditions that can cause severe ankle pain, along with how to identify each of them.

6 Possible Severe Ankle Pain Conditions

The list below shows results from the use of our quiz by Buoy users who experienced severe ankle pain. This list does not constitute medical advice and may not accurately represent what you have.

Ankle sprain

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.

Rarity: Common

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

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

Chronic ankle bone infection (osteomyelitis)

Osteomyelitis of the ankle is a bacterial or fungal infection of the ankle bones, typically caused by Staph Aureus (40-50% of the time). It is difficult to diagnose as the infection can come from a break in the skin at the area or anywhere else in the body that spreads by blood.

Rarity: Rare

Top Symptoms: spontaneous ankle pain, moderate fever, warm red ankle swelling, painful surgical site

Symptoms that always occur with chronic ankle bone infection (osteomyelitis): spontaneous ankle pain

Urgency: Hospital emergency room

Severe Ankle Pain Symptom Checker

Take a quiz to find out what might be causing your severe ankle pain

Ankle arthritis

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.

Rarity: Uncommon

Top Symptoms: swollen ankle, swollen foot, joint stiffness, pain in one ankle, ankle stiffness

Urgency: Self-treatment

Ankle bruise

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.

Rarity: Rare

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

Urgency: Self-treatment


Gout is a form of arthritis that causes sudden pain, stiffness, and swelling in a joint. The big toe is often affected.

Rarity: Common

Top Symptoms: swollen toes

Urgency: Primary care doctor

Severe Ankle Pain Treatments and Relief

If your severe ankle pain persists or is not helped by at-home remedies, you should consult your physician. You should also seek immediate treatment for any injury causing significant pain or trauma or any indication of infection.

At-home treatments

At-home remedies that may be helpful in treating your ankle pain may include [2]:

  • RICE: This mnemonic stands for rest, ice, compression via a bandage, and elevation. You can also take over-the-counter pain relievers such as ibuprofen.
  • Supportive shoes: Wear properly fitted shoes for all activities and avoid high heels.
  • Proper exercise techniques: Warm up properly before exercising to avoid strains, sprains, and overuse.

Medical treatments

You should consult your physician for further treatment to address the following.

  • Difficulty walking: This is being unable to bear weight on the ankle and can indicate ankle damage that can only be fixed with a procedure.
  • Continued symptoms: Pain and swelling that does not resolve after a day or so of rest should be discussed with your physician.

When severe ankle pain is an emergency

If you experience the following below, you should seek immediate treatment:

  • There is evidence of trauma: Such as obvious fracture of the ankle, or it looks misshapen as though something is out of place.
  • There are signs of infection: The ankle is hot, red, and swollen, either with or without an open wound.

Real-life Stories

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FAQs About Severe Ankle Pain

Here are some frequently asked questions about severe ankle pain.

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 [7]. 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 Severe Ankle Pain

To diagnose this condition, your doctor would likely ask the following questions:

  • How would you explain your ankle pain?
  • Any fever today or during the last week?
  • Have you ever been diagnosed with diabetes?
  • What is your body mass?

If you've answered yes to one or more of these questions

Severe Ankle Pain Symptom Checker

Take a quiz to find out what might be causing your severe ankle pain

Severe Ankle Pain Symptom Checker Statistics

People who have experienced severe ankle pain have also experienced:

  • 12% Swollen Ankle
  • 4% Pain In One Ankle
  • 3% Swollen Ankle

People who have experienced severe ankle pain were most often matched with:

  • 54% Chronic Ankle Bone Infection (Osteomyelitis)
  • 27% Posterior Tibialis Tendinopathy
  • 18% Ankle Sprain

People who have experienced severe ankle pain had symptoms persist for:

  • 33% Over a month
  • 26% Less than a week
  • 21% Less than a day

Source: Aggregated and anonymized results from Buoy Assistant (a.k.a. the quiz).

Severe Ankle Pain Symptom Checker

Take a quiz to find out what might be causing your severe ankle pain


  1. Polzer H, Kanz KG, Prall WC, et al. Diagnosis and Treatment of Acute Ankle Injuries: Development of an Evidence-Based Algorithm. Orthopedic Review. 2011;4(1):e5. NCBI Link
  2. Rao S, Riskowski JL, Hannan MT. Musculoskeletal Conditions of the Foot and Ankle: Assessments and Treatment Options. Best Practice & Research: Clinical Rheumatology. 2012;26(3):345-368. NCBI Link
  3. Arthritis and Diseases that Affect the Ankle. Arthritis Foundation. Arthritis Foundation Link
  4. Tiemstra JD. Update on Acute Ankle Sprains. American Family Physician. 2012;85(12):1170-1176. AAFP Link
  5. Yue D, Ho J, Al-Hadithy N. A Case of Sudden Ankle Pain. BMJ. 2012;345. BMJ Link
  6. Pedowitz D, Kirwan G. Achilles Tendon Ruptures. Current Reviews in Musculoskeletal Medicine. 2013;6(4):285-293. NCBI Link
  7. Gulati V, Jaggard M, Al-Nammari SS, et al. Management of Achilles Tendon Injury: A Current Concepts Systematic Review. World Journal of Orthopedics. 2015;6(4):380-386. NCBI Link

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