different types of ankle pain

Different Types of Ankle Pain and What They Mean

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Medically reviewed by Misty Seidenburg

Ankle pain has a wide range of causes. It can be linked to a specific trauma to the foot or leg, or be related to a systemic condition that affects the entire body. It’s important not to dismiss ankle pain because when left untreated, it can lead to chronic pain and more serious, long-term problems.

Let’s look at the different types of ankle pain and treatments to relieve symptoms and improve mobility and function.

Basic Ankle Anatomy

Before we dive in to the various types of ankle pain, it’s helpful to have a basic understanding of ankle structures and movement.

The shin bones of the lower leg (tibia and fibula) and talus bone meet to form the ankle joint. The ankle joint connects the foot to the lower leg. The ankle contains cartilage, ligaments, muscles, nerves, and blood vessels.

The ankle is classified as a synovial joint, and these joints are the most common and freely mobile types of joints in the body. It’s also a hinge joint, so it moves like a hinge does to open and close. The ankle bends and flexes during movement to maintain balance and stabilize the body.

What Does Ankle Pain Feel Like?

Acute injuries, disease, or genetic conditions affecting any of these structures can cause pain in the ankle. Ankle pain can be aching, throbbing, shooting, stabbing, dull, or burning. It can come on suddenly during specific movements, or linger for long periods of time, regardless of the type of physical activity.

The location and nature of ankle pain helps physical therapists and other healthcare providers to evaluate and diagnose the underlying cause. Imaging tests also help to identify damage or disease. From there, a treatment plan is created.

Front Ankle Pain

Ankle impingement, or “footballer’s ankle” is one common cause of pain in the front, or ‘anterior’ side, of the ankle joint. Impingement involves chronic pain due to bone spurs or scar tissue from a single injury or repeated stress.

Sports and movements that involve repeated upward bending of the foot (dorsiflexion) can cause impingement. Activities more likely to lead to impingement include basketball, soccer, football, running, and ballet.

Pain from impingement often occurs at the top of the foot when bending it upwards. Some people also experience dull aching and/or swelling in the front of the ankle when it’s resting. The top of the ankle can also be tender to the touch.

Outside Ankle Pain

Pain on the outside, or ‘lateral’ aspect, of the ankle is a possible symptom of several injuries and conditions, including:

  • Arthritis: Osteoarthritis, rheumatoid arthritis, and other forms of arthritis can cause pain, stiffness, and swelling in the ankle joint.
  • Fractures: A break in the bone located on the outside of the ankle joint (lateral malleolus) is the most common type of ankle fracture that causes outside ankle pain.
  • Lateral ankle sprains: Overstretching or tearing of the fibrous ligaments that connect bone to bone from sudden or frequent twisting, turning, or rolling of the ankle can result in a painful ankle sprain.
  • Tendonitis: Peroneal tendonitis is inflammation of one or both tendons that connect the lower leg to the foot and run along the outer ankle bone.

Because symptoms may overlap for these common conditions, it is important to see your healthcare provider for an accurate diagnosis if symptoms don’t resolve with home care within a few days.

Ankle Pain When Walking

Like pain in other areas of the foot, ankle pain when walking can be a sign of multiple conditions including some we’ve already mentioned including  sprains, and broken bones. Arthritis and bursitis also cause discomfort during walking.

Arthritis

Pain when walking can be a sign of a form of arthritis, and is often accompanied by stiffness or swelling in the joint. Osteoarthritis (OA) is the most common form of arthritis and happens due to wear and tear that gradually breaks down the supportive joint cartilage over time.

Ankle pain when walking can also be a sign of chronic inflammation in the joints (rheumatoid arthritis), reactive arthritis that develops following infection in the body, and gout which develops as a result of excess uric acid in the bloodstream.

Bursitis

Ankle pain when walking can also be caused by bursitis. This is inflammation of the small bursae sacs that cushion and reduce friction between the joints and tissues during movement. Overuse or injuries can irritate or inflame bursae in the ankle, resulting in pain and swelling, especially during walking and other movements.

Ankle Pain After Running

Pain in the ankles after running can occur from a single injury, or be related to a chronic condition. Sprains and strains often happen when the runner’s foot becomes unstable, causing it to bend or twist unnaturally. Running on uneven surfaces or quick changes in speed or direction can also damage or tear the connective tissues in the ankle.

Symptoms of a possible ankle sprain or strain include:

  • Ankle swelling and pain (at rest and activity)
  • Visible swelling in the injured ankle
  • Bruising in the injured ankle
  • Ankle tenderness to the touch
  • Instability, feeling like the ankle is going to “give out”

A severe ankle sprain requires prompt evaluation by a healthcare provider. Left untreated, sprains and strains can lead to more serious conditions.

Back Ankle Pain

Pain at the back, or posterior side of the ankle may be one of the most common signs of an injury or disease of the ankle joint. It can make everyday movements and tasks painful and difficult to complete. Common causes of pain in the back of the ankle include arthritis, bursitis, fractures, sprains and strains, and Achilles tendonitis and tendinopathy.

The Achilles tendon is the largest tendon in the body. It runs down the back of the lower leg, connecting the calf muscles to the heel bone. Tendonitis is inflammation of the Achilles tendon due to prolonged stress. Tendinopathy is the break down of the collagen that forms the tendon. Both cause pain and swelling at the back of the ankle that worsens with activity.

Physical Therapy for Ankle Pain

Many patients achieve long term relief from ankle pain with physical therapy. Treatment starts with an initial assessment to evaluate your pain and determine if and how certain movements exacerbate your symptoms.

Once your physical therapist identifies the underlying cause of ankle pain, they create a customized program to manage your symptoms and improve function and range of motion in the ankle joint.

PT for ankle pain might include the following therapies and treatments:

  • Exercise therapy: Physical therapists use targeted movements to build ankle strength, balance, and improve flexibility for long-term symptom relief.
  • Stretching: Stretching the calves and other connecting tissues can help alleviate ankle pain and stiffness
  • Manual therapy: Massage, joint mobilization, instrument-assisted soft tissue mobilization (IASTM), and other hand-on techniques enhance mobility and function in tight, painful muscles and other tissues.
  • Dry needling: Dry needling involves the insertion of small, sterile needles into the skin to release tight, muscle knots. It can be especially helpful for ankle pain due to Achilles tendonitis.
  • Additional modalities: Physical therapists may also incorporate heat and cold therapy, electrical stimulation, and ultrasound into your program for immediate symptom relief.

While there is a high rate of recurrence for ankle injuries, physical therapy is highly-effective for helping patients avoid reinjury.  Prevention is a key component of a physical therapy program for ankle pain. Your therapist provides guidance on things you can do at home to keep your ankles strong and healthy.

That can include everything from stretching and strengthening exercises to tips for choosing the right footwear to protect and support the joint.

Closing Thoughts on Treating Ankle Pain

Some minor ankle pain can improve with the P.E.A.C.E. & L.O.V.E. protocol for treating soft tissue injuries (an updated variation of the R.I.C.E. method.) Others require physical therapy to improve movement, function, and range of motion and prevent recurrence.

In some cases, surgery is necessary to repair injuries and restore healthy movement. Seek immediate medical care if you have severe pain or swelling after an ankle injury, your pain seems to be getting worse, or you notice obvious signs of deformity or an open wound.

Is nagging ankle pain keeping you from being as active as you’d like to be? Find a physical therapy clinic near you.

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Medically reviewed by

Misty Seidenburg

Vice President of Clinical Programs

Dr. Misty Seidenburg has been a practicing physical therapist since 2006 after obtaining her Doctor of Physical Therapy Degree from Gannon University. Dr. Seidenburg completed an Orthopedic Residency in 2009 and subsequent Spine Fellowship in 2010 where she discovered a passion for educating clinicians. Since 2019, she has developed and refined several post-professional residency and fellowship programs and currently serves as the Vice President of Clinical Programs for Upstream Rehab Institute. She serves on several APTA committees to help advance the profession, is adjunct faculty at Messiah University, and is also a senior instructor and course developer for the Institute of Advanced Musculoskeletal Treatments with a special interest in exercise integration. Outside of work, she enjoys challenging herself with new adventures and is currently competing as an endurance athlete.

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