Doctor treating patient with Ankle Pain Without Injury

What Can Cause Ankle Pain Without An Injury?


Do you have ankle pain, without an injury that you can recall? You are not alone. An estimated 15% of middle-aged and older adults have frequent ankle pain. Ankle pain can impact function and mobility and keep you from doing all of the activities you enjoy.

In this article, we will explore common causes of ankle pain for people who have not experienced a noticeable injury and highlight treatments to get you back to moving sooner rather than later.

Understanding the Anatomy of the Ankle

To understand the conditions that can cause sudden ankle pain without injury, it’s helpful to become familiar with the structures of the ankle

The ankle, or talocrural joint, is a large, weight-bearing joint that allows the foot to move up and down. It is made up of three bones: the tibia or shin bone, the fibula which is the thinner bone located next to the shin bone, and the talus which is a foot bone that rests above the heel bone.

The bony protrusions that you can see and feel on the sides and back of your ankle are the: medial malleolus, lateral malleolus, and posterior malleolus. The subtalar joint sits below the ankle joint and allows the foot to move side to side.

Numerous ligaments made of thick, durable tissue surround and support these joints and connect them to the bones of the feet and legs. Conditions that cause ankle pain can involve any of these structures that form the ankle.

Trauma from a fall or other type of accident can result in immediate pain and other symptoms. Fractures, sprains, and strains are examples of these injuries. But other conditions may not be related to a single event.

Proper diagnosis is the key to successful treatment—and relief from ankle pain without an injury

A wide range of conditions can cause ankle pain without injury. Here are some of the most common:

1. Infection

Several types of skin infection can lead to pain and swelling of the ankle joint. Cellulitis is one common bacterial infection that often enters the body through a wound on the skin. It typically affects the lower body including the legs and feet but can occur throughout the body.

2. Flatfoot

Flatfoot is a common medical condition that varies in severity and deformity from person to person. All types of flatfoot have one symptom in common: partial or total collapse of the arches of the feet.  This condition can be normal in some people, but in others can create painful conditions.

The most common version of this condition is flexible flatfoot which generally appears in childhood in both feet and may increase in severity with age. As flexible flatfoot becomes more severe, the ligaments and tendons of the arch can stretch or tear causing ankle and foot pain that may travel up to the shins, lower back, and hips.

Orthotic devices to support arches and physical therapy to ease pain can make a difference for people with flat feet.

3. Bursitis

Bursitis is inflammation of the fluid-filled sacs that cushion the tissues of the body. Infection, overuse, or injury can cause bursitis. In addition to pain, someone with bursitis may have tenderness, redness, swelling, and limited motion in the affected area.

Retro malleolar bursitis and posterior Achilles tendon bursitis are two types of bursitis that involve the Achilles tendon, the fibrous tissue that connects the calf muscles to the heel bone. Bursitis that isn’t related to infection is usually treated with rest, ice, compression, and elevation (R.I.C.E.) and medication.

4. Gout

Gout is a particularly painful type of inflammatory arthritis that often affects one joint at a time. The cause is a condition called hyperuricemia which is when there is too much uric acid in the body.

Gout often affects the big toe but can also cause pain and swelling in the other toe joints, the ankle, and the knee. Gout is marked by sudden flares that can last anywhere from a few days to a few weeks. Treatment for gout usually includes medications for pain and inflammation and lifestyle changes to prevent future flares.

5. Osteoarthritis

Osteoarthritis is the most common form of arthritis. It mostly affects the joints of the knees, hand, ships, and spine, but can impact any joint in the body including those of the feet and ankles.

Osteoarthritis damages the slippery, tough substance at the end of our bones, called cartilage. When the cartilage is damaged, the bones can rub together resulting in pain and swelling. Beyond the cartilage, osteoarthritis can also damage the ligaments, tendons, and bones in affected joints.

Someone with osteoarthritis of the foot or ankle may have pain, swelling, and instability in their joints. In many cases, ankle arthritis is actually connected to prior trauma, though symptoms may not present until well after the initial injury. Physical therapy, pain management, podiatry, and surgery may be recommended for people with ankle pain due to osteoarthritis.

6. Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic autoimmune disorder where the immune system mistakenly attacks the body. RA affects the lining of the joints and can potentially result in bone erosion and joint deformity.

Like gout, RA may come and go in cycles, causing flares that last a few days to weeks. RA in the ankle joints can cause pain, stiffness, inflammation, and weak or unstable joints. Someone with RA can have trouble standing or walking, especially uphill. Exercise, medication, and anti-inflammatory foods can help reduce the severity of ankle pain and improve mobility.

7. Achilles Tendonitis

Pain located at the back of the ankle can indicate Achilles tendinitis, or tendinopathy.  Tendonitis is inflammation of the thickest, strongest tendon in the body, the Achilles tendon.

While the Achilles tendon can tolerate significant tension and stress, it is also prone to irritation. Generally, ankle pain from tendonitis is mild to moderate. However, in more severe cases, the tendon can actually rupture.

Inflammation of the Achilles tendon can occur through improper footwear, abnormal foot biomechanics (like flatfoot), or repeated and intense stress and strain. Rest, strength training, and physical therapy can be beneficial for people with ankle pain caused by tendonitis.

Physical Therapy for Ankle Pain With or Without An Injury

Depending upon the diagnosis, physical therapy may be part of a comprehensive treatment plan for ankle pain with or without injury. Working with a physical therapist can help someone with ankle pain in many ways.

If you have ankle pain, physical therapy can help:

  • Reduce pain
  • Improve balance
  • Increase ankle mobility
  • Improve range of motion
  • Restore use of the ankle joint
  • Stretch and strengthen the ankle
  • Reduce the need for medication
  • Reduce the need for surgery

Physical therapy employs a range of therapies customized to meet the patient’s needs and treatment goals. Exercise, manual therapy, and balance training can benefit people with ankle and foot pain.

If your symptoms are impacting your mobility, speak with your healthcare provider and visit a clinic to find out if physical therapy improve your symptoms. Find a physical therapy clinic near you.

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