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.
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.
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.
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.
Pain on the outside, or ‘lateral’ aspect, of the ankle is a possible symptom of several injuries and conditions, including:
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.
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.
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.
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.
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:
A severe ankle sprain requires prompt evaluation by a healthcare provider. Left untreated, sprains and strains can lead to more serious conditions.
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.
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:
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.
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.