Why Does My Ankle Hurt? Causes, Symptoms & Treatment
Sprains, strains, and fractures are the three most common causes of ankle pain. But what if you can’t recall hurting or rolling your ankle, and you’re experiencing ankle pain?
Your ankle is the joint responsible for the up and down, side to side movements of your feet. There are a bunch of different ligaments that surround the ankle bone and joint, which work to stabilise and connect the bones in your leg to your feet. More often than not, ankle pain is due to injury or trauma to these ligaments. In some cases, however, ankle pain can be caused by a medical condition like rheumatoid arthritis.
Ankle pain can vary in causes, symptoms, and treatments. What might work for a sprained ankle, isn’t necessarily going to provide relief for a medical condition. As always, if you are experiencing sudden ankle pain with no known cause, it’s best to see your doctor or physio for assessment and treatment.
However, we know you didn’t come to Google just to get told to go to the doctor; you’re here because you want answers on what’s causing pain, and how to fix it. Along with the caveat that medical advice is always recommended, we can certainly provide a detailed outline of ankle pain causes, symptoms, and treatment. If you’re looking for treatment solutions, you can skip to the bottom of this article.
Table of contents
What can cause ankle pain
Causes of ankle pain without injury
What is ankle pain a symptom of
How to know if ankle pain is serious
How is ankle pain diagnosed
Ankle pain treatment
What can cause ankle pain?
The most common cause of ankle pain is an injury. This may occur during walking, running, exercising, or playing sport, resulting in either a bruise, sprain, strain, or fracture. Most specifically, these ankle injuries are more obvious, and are pretty common when playing sport.
Sports that wreak havoc on your ankles include:
These sports are known for being high impact on the ankles, which can result in overtwisting the ligaments, an ankle sprain, a strain, or a fracture of the ankle bone. Twisting, tripping, rolling, falling, or impact to the ankle are the most common actions that will cause a sprain, strain, or fracture.
Ankle injuries can be hard to discern, as an ankle sprain can present the same symptoms of a broken ankle, or even a ligament tear, in the immediate aftermath. Pain may occur at the time of an incident, and become immediately swollen, or the ankle may start to become more painful after the game has concluded, and you’re left with a stiff, swollen, and problems bearing weight. Generally, a fractured ankle won’t be able to bear weight - but this is also pretty common with bad sprains and strains too. To accurately diagnose the injury, you’ll either need an X-ray or an MRI to identify a fracture or a torn ligament.
Other causes of ankle pain may not be directly related to a physical injury or motion, and may instead be related to a medical condition like arthritis, cellulitis, fibromyalgia, or gout. And if there’s no medical condition present? Alternate reasons that may cause ankle pain that are not related to a physical injury or medical condition are harder to diagnose, but can be as simply explained as poorly fitting shoes, foot alignment issues, or even overuse from day-to-day mobility.
What causes ankle pain without injury?
As mentioned above, ankle pain can also occur without an obvious injury. Sudden pain in the ankle area can be caused by autoimmune conditions, arthritis, or alignment issues. The good news is, that given the position, location, and nature of the ankle joint, ankle pain can almost always be explained.
Here are some of the potential causes of pain, if you’ve not had an obvious injury to the area:
Arthritis variants like osteoarthritis and rheumatoid arthritis can cause sudden, unexplained pain in the ankle joint. Osteoarthritis occurs when the cartilage cushion between two bones has worn away, causing the bones to rub directly against each other. It can be extremely painful, particularly in the mornings. Rheumatoid arthritis is a chronic autoimmune disease wherein the immune response is to attack its own healthy cells, including those in the ankle. RA can cause swelling, pain, and stiffness in the joint, restricting mobility.
Achilles tendonitis is an overuse injury that can come from walking, running, hiking, or even dancing. The achilles tendon stretches across and connects the heel bone to the calf, and when overstretched, can become very inflamed and result in achilles tendonitis. The symptoms of achilles tendonitis can range from pain, to swelling, weakness, and reduced movement, and of course, ankle pain.
Ankle pain may also be caused by flat feet - a condition that has resulted in a slight deformation of the foot where the arches have collapsed and the feet are flat. Flat feet can occur over time as arches start to drop, and can result in ankle pain as the collapsed arch creates more pressure on the ankle bone.
Gout is an inflammatory condition that can cause sudden and intense pain in the ankle joint. It will usually come with swelling, redness, and stiffness in the area, making it hard to walk. Caused by a build-up of a substance called uric acid in the blood, gout presents when uric acid builds up and causes tiny sharp crystals to form in and around joints - like the ankle.
Ankle bursitis presents when one or more of the bursae sacs (a small, fluid-filled sac) in the ankle become inflamed, causing pain, swelling, and difficulty moving the ankle joint. These little sacs are responsible for cushioning between the bones, and can become inflamed because of an injury, overuse, or stress on the ankle.
Lupus is a relatively rare disorder; however, it’s worth noting that one of the symptoms can be ankle pain. The autoimmune disease occurs when the body’s immune system attacks tissues and organs, resulting in severe inflammation. Lupus can affect many different parts of the body, including your joints, which can result in ankle pain.
Plantar fasciitis is the inflammation of the plantar fascia, the tissue that connects the bottom of your foot to your heel, and your toes. Plantar fasciitis usually presents in pain in the heel bone, but it’s not uncommon for pain to present in the ankle too. It can feel like a sharp stabbing pain when you move the affected foot, or a dull constant ache, even when you’re resting. Plantar fasciitis is a classic overuse injury that can present from different walking surfaces, increased load (if you’re running or walking more), or even from wearing the wrong shoes.
Poorly fitting shoes
If you’re wearing shoes that don’t fit properly - too tight, too loose, don’t have enough support, or are too high, this may be what is causing ankle pain. Whether it be for sport, work, or everyday activities, it’s important to wear footwear that are supportive and fit well.
Scleroderma is an autoimmune disease that causes inflammation and fibrosis in the body. In particular, the condition can weaken the tissues in the body, causing changes to the feet and joints in the feet, resulting in a “walking on pebbles'' feeling when walking. One of the more obscure potential causes of ankle pain, scleroderma can be extremely uncomfortable in both the hands and feet.
How do I know if ankle pain is serious?
If you haven’t already picked up on it, most of the causes of ankle pain come with similar accompanying symptoms: swelling, stiffness, and reduced mobility. So, how do you know if your ankle pain is due to a simple sprain, or conversely, something that you should be worried about?
Generally if you have:
Severe pain that continues to get worse with time
Have an open wound or the ankle looks deformed or out of place
Have signs of an infection, such as redness, warmth, and tenderness and a fever
Cannot put weight on the foot even after a day or two of rest
Have joint pain in other areas of your body outside of the ankle area
You should treat your ankle pain with more caution and seek urgent medical attention. Even if it turns out to be a mild to moderate sprain, it’s better to be safe than sorry.
Ankle pain treatment
Ankle pain treatment will vary depending on the cause of the pain. However, it’s very common for ankle pain to be accompanied by swelling and inflammation (lucky you). In which case, the RICE treatment is almost always recommended if you’ve got ankle pain. The RICE treatment includes:
If your ankle pain is from injury:
If you’ve injured your ankle playing sport, start with the RICE treatment. There’s an age old saying that fractures will burn when you use ice; however, icing the area can be an important step in reducing inflammation, whether the ankle is broken or not. From there, if the ankle pain does not start to get better and you can’t bear weight after a day or two, it’s important that you get a diagnosis through a physiotherapist or doctor who can refer you on for an X-ray or MRI scan to confirm whether it’s a fracture, sprain, or strain.
Sprains & Strains
Generally speaking, mild to low-grade ankle sprains and strains will usually heal in one to three weeks with the RICE method. For moderate sprains or strains, the injury can take between three to four weeks, and severe injuries can take up to three to six months to fully recover. Depending on the severity of the sprain or strain, treatment may also include using sports tape, ankle support, or a moon boot.
Fractures will need to be properly identified and diagnosed with an X-ray. If you suspect that you’ve broken your ankle, it’s important to seek urgent medical attention. From there, a doctor will be able to work out the severity of the fracture, whether it will heal on its own, or whether surgery is required. It goes without saying (or so it should), that any ankle injury that has broken through the skin needs to be attended to immediately in the Emergency department.
Whether or not treatment will include surgery will depend on the number and location of fractures in the ankle. Ankle fractures can take much longer to heal than sprains and strains, and will take longer if surgery is required to allow for rehab. The average time to heal for a broken ankle without surgery is between 12 to 16 weeks.
If you’re not sure of the cause:
Treatment for ankle pain can vary if you haven’t had an obvious injury like a fall, trip, or twisted ankle. Based on the medical conditions/alternative causes for ankle pain, here’s what the treatment might look like for each:
Arthritis: your doctor may recommend medication, ankle support, or exercise to help alleviate ankle pain. Depending on the type and severity of arthritis, steroid injections, surgery, and heavy medication may also be prescribed.
Poor alignment, flat feet, plantar fasciitis: Orthotics and shoe inserts are the best treatment for this type of ankle pain. If you have fallen arches, poor alignment, or plantar fasciitis, it’s worth seeing a physiotherapist to help you with an orthotic fitting and treat ankle pain that comes with poor alignment when walking and running.
Gout: If you have gout, you may be already taking medication or on a treatment plan to help and prevent painful flare-ups. However, if you’re experiencing a bout of gout in your ankle, anti-inflammatories and ice packs can help to reduce swelling and relieve pain.
Auto-immune diseases: Lupus, scleroderma, and rheumatoid arthritis are naturally going to have very different treatment solutions outside of rest, ice and compression. Your doctor may recommend nonsteroidal anti-inflammatory medication, pain relief, or other treatments depending on how the disease affects the rest of your body.
Achilles tendonitis: Orthotics also work well for achilles tendonitis. Pain relief will involve reducing exercise, resting, and anti-inflammatory treatments. From there, recovery will also include stretching and strengthening, which is best conducted under the guidance of your physio.