Ankle Pain

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The ankle is the joint at the intersection of the two lower leg bones (tibia and fibula) and the foot bone (talus). It is one of the principal weight bearing joints in the body and is also required to carry out several complex and important functions in everyday life. Perhaps because of these reasons, ankle pain is a relatively common experience for many of us.

The most common causes of ankle pain are probably

  • Ankle sprains and other soft tissue injuries;
  • Ankle arthritis;
  • A fractured ankle;
  • Flat feet; and
  • Ankle infections (either bones or soft tissues).

In this article, we examine these five most common reasons for a painful ankle. We first discuss the most likely accompanying symptoms for each cause. We will then suggest the next steps you can take to get some relief from the pain by treating its underlying cause.

Ankle Soft Tissue Injuries

Ankle Sprains

These are probably the most common sports related injuries suffered by North American teenagers and adults. They are the result of damage to ankle tendons due to excessive ankle rotation. The rotation can be either inward (toward the centre of the body) or outward (away from the centre). The most common type of ankle sprain is caused by inward rotation and is called an inversion sprain.


In addition to ankle pain, a sprain will usually cause swelling and tenderness of the ankle. Ankle range of motion may be reduced, possibly significantly if the sprain is severe. And your ability to put weight on the joint will be compromised. With a severe sprain, you will probably not be able to walk or even stand without the aid of crutches.

Ankle Bursitis

This is another soft tissue ankle injury that is caused by irritation and then inflammation of the fluid filled sacs in the ankle joint. These sacs assist the tendons to move smoothly over adjacent bones in the joint. Ankle bursitis can be a result of overuse of the joint or it can be due to trauma or infection.


Ankle bursitis will cause pain and swelling  (usually at the back of the ankle, near the heel bone). The joint can become stiff and its ability to bear weight will again be reduced.

Ankle Tendonitis

This is the third of the three most common ankle soft tissue injuries. It is a result of the irritation and inflammation of the tendons in the ankle that connect lower leg muscles to ankle bones. Specific examples of this injury are peroneal tendonitis and achilles tendonitis.


If you have ankle tendonitis, you will experience pain in the region of the injured tendons, as well as warmth and swelling in the same area. The pain will usually be at its worst when you are active and will tend to recede during rest periods.

Suggested Treatments For Ankle Soft Tissue Injuries

With all ankle soft tissue injuries, the key to successful treatment is resting the tissues. Reduce your activity level.  Specifically, avoid high impact activities like walking, running or jumping, as these are toughest on the ankle joint. Consider swimming, cycling or other low impact activities if you must have some alternative exercise.

An ankle brace can be useful in protecting the ankle from another rotation that could reinjure the ligaments damaged by a sprain.

Ice the ankle joint by applying a cold compress for 20 minutes every 2-3 hours. This will ease the pain and will also help reduce swelling. For further pain relief, consider a simple pain relief medication like Tylenol. For relief of both pain and inflammation, consider aspirin, Naproxen or Ibuprofen.

Compression of the ankle using a tensor bandage or ankle sleeve can help to improve blood flow through the joint once the pain has eased. You can also consider switching from cold to hot therapy at that point for the same reason.

Cold therapy and compression may be effectively combined to treat ankle injuries by using a cold therapy machine such as the Cryo Cuff.

Elevate your ankle above heart level to aid the return of blood to your heart.

A therapist who can design a physical therapy exercise program to strengthen your lower leg muscles and improve the flexibility of ankle tissues. These exercises will help reduce the risk of another soft tissue injury after you have returned to regular activity.

Ankle Arthritis

There are many types of arthritis but the ones most likely to lead to foot and ankle pain are osteoarthritis, rheumatoid arthritis and gout.

Ankle Osteoarthritis

This is caused by wear and tear of the cartilage covering the bone ends in the joint. As a result of this, the bone ends start to come into direct contact with each other. The result is joint pain and stiffness.

Rheumatoid Arthritis (RA) Of the Ankle

This type of arthritis is the result of the immune system becoming hyperactive and attacking the synovial joint lining. Since this lining is intended to allow the joint to move smoothly and frictionlessly, the effect of its destruction is joint pain and stiffness.


This form of arthritis is a result of the accumulation of excess uric acid in the bloodstream. When this happens, uric acid crystals accumulate in the joints and most typically in the ankle of just behind the big toe.

As with the other two forms of arthritis, the effect of joint pain and stiffness. With gout, the pain can be particularly severe during the night.

With all forms of arthritis, ankle pain will tend to be worse when you awaken in the morning. It will also tend to be severe when resuming activity after a daytime rest. In addition to ankle pain, you will experience stiffness and loss of range of motion. The joint itself may become red and swollen, particularly if inflammation is present.

In the long term, the impact of RA can spread well beyond the ankle. The persistently high level of inflammation that it produces can cause problems with blood vessels and internal organs. Eyesight, hearing and a host of other functions can also be impaired by high levels of inflammation.

Suggested Treatments For Ankle Arthritis

Arthritis has no cure, so its symptoms cannot be reversed.

However, if you believe your ankle pain may be due to arthritis, you can visit a doctor for advice on how to slow its rate of progression.

Doctors can prescribe painkillers to reduce the discomfort of the disease. In addition, if inflammation is a problem (as for example with gout), they can prescribe non steroidal anti inflammatory drugs to control it.

For additional inflammation control, doctors can also administer corticosteroidal injections into the joint to further combat inflammation.

Doctors can prescribe a range of medications to address rheumatoid arthritis. For example, immune suppressing drugs can help to save the joint lining from further attack.

For all forms of arthritis, physical therapy can help to preserve ankle joint range of motion and reduce pain.

Gout can also be treated by making dietary changes. Specifically, reducing the amount of purine rich foods that you consume can help reduce the incidence of this form of ankle pain.

One home based approach to controlling ankle pain due to arthritis may be to use heat therapy. Apply a hot compress regularly to increase blood flow through the joint. This will also help to reduce joint stiffness. Moist heat therapy has also been reported to be effective in combating arthritic pain.

Ankle Fracture

A broken ankle covers a wide range of types of bone fractures. There are stress, compound, hairline and open fractures, to name a few.

Virtually all ankle fractures will however cause pain, swelling and bruising of the joint. If the fracture is a serious one, it will also change the shape of the ankle itself. A very serious fracture can also cause bone fragments to penetrate the skin and be visible to the naked eye. This is what is known as an open fracture.


If you think you have suffered an ankle fracture, you should consult a doctor immediately. This is not an injury you can treat at home.

Treatment of a fracture may require surgery to repair bone damage and to move the bones back to their correct positions. Once this is done, the ankle will need to be placed in a cast to ensure the bones heal in their correct positions. While you are wearing the cast, you will need crutches to move around.

To bathe or showerwhile wearing your cast, you may need to use a waterproof cast cover such as the DryPro cast cover.

Once your fracture has healed sufficiently, doctors will remove the cast. However, you may still need to wear a walking boot to stabilize and protect your ankle while it heals further.

Physical therapy will again be an important component of your treatment. It will strengthen the joint as you return to regular activity and ensure you recover all the range of motion you may have lost.

Flat Feet

Adult acquired flat foot is a condition caused by injury to one of the foot tendons – the posterior tendon. This tendon is responsible for providing  support to the foot. Consequently an injury to this tendon causes the foot arches to flatten.

The result is pain and swelling on the inner side of the ankle. Over time, this spreads to the outer ankle also.


You can control the pain and swelling this condition causes by icing your ankle, just as described above for soft tissue injuries.If possible, a period of rest will also cause the pain to ease.

Painkillers such as Tylenol can help to provide some relief from flat foot ankle pain.

You can also have a pair of custom made shoe inserts made to provide your arches with an external source of support.Over the shelf inserts can also be purchased as a relatively inexpensive alternative.

Instead of inserts, you may also be able to buy shoes that have the required degree of arch support built in.

Certain types of ankle braces  such as the BioSkin Trilok contain features to fight ankle pain due to posterior tendon dysfunction..

If the above home based remedies do not work, see a doctor. He or she may recommend corticosteroid injections near the posterior tendon. This is an aggressive approach to fighting inflammation that may have damaged the tendon and caused the arch collapse.


Ankle pain may also be a result of infections of the joint. These infections may be in the skin over the joint or in its soft tissues. They may also be present in the ankle bones, a type of infection known as osteomyelitis

If you have an ankle infection, the pain will usually be accompanied by swelling, redness and a “tender to the touch” feeling.You may also be able to detect the presence of inflammation fluid (pus) in the painful part of the ankle.

The pain will be fairly consistent. Unlike pain due to arthritis or soft tissue injuries, it will not vary with the time of day or your activity level..


If you think your ankle pain may be due to an infection, we would again strongly suggest seeing a doctor for medical advice. Infections, if left untreated, can become more general in nature and lead to life threatening conditions (e.g. sepsis).

A doctor will probably take a sample of the inflammation fluid to determine the type of bacteria causing the infection. In the meantime, he or she may aspirate the joint by draining the inflammatory fluid from it with a needle. He or she may also prescribe a generalized type of antibiotic pending the results of the fluid sample test.

Once the type of bacteria causing the infection has been determined (from the test) the doctor may switch to a more specialized type of antibiotic. This will be used to fight the infection more effectively and bring an end to your ankle pain.

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