SymptomBones, joints & muscles
Ankle Pain: Causes, Location Clues and Treatment
Ankle pain is pain in or around the ankle joint, where the shin bones meet the foot. Most ankle pain follows an injury, usually a sprain from rolling the ankle. Pain without an injury often comes from an inflamed tendon, arthritis, gout or a stress fracture. Where the pain sits (outside, inside, front or back of the ankle) is the best clue to the cause. Most ankle pain settles with rest, ice and gradual exercise, but inability to bear weight or a hot, swollen joint needs prompt care.
Also called: Ankle ache, painful ankle, ankle joint pain, ankle discomfort
At a glance
- Most common cause
- A sprained ankle (stretched or torn ligaments, usually on the outside).
- Without injury
- Tendinitis, arthritis, gout, stress fractures and nerve compression.
- Location clue
- Outside means sprain or peroneal tendons; inside means posterior tibial tendon or tarsal tunnel; back means Achilles tendon.
- When to get an X-ray
- If you cannot take 4 steps or the ankle bones are tender to press.
- Treatment
- Rest, ice, compression, elevation, then balance and strength exercises.
When to get help
Call 911 or go to the ER
- An ankle that looks deformed, with bone through the skin, or a foot that is cold, pale or numb after an injury
- A hot, red, swollen ankle with fever above 38 °C (100.4 °F) and inability to move it (possible joint infection)
See a doctor within a day or two
- Unable to take 4 steps after an injury, or tenderness when pressing the back edge of the ankle bones
- A pop at the back of the ankle with weakness pushing off (possible Achilles rupture)
- A sudden, very painful, red, swollen ankle without injury (possible gout or infection)
- A swollen, tender calf with ankle swelling (possible DVT)
Book a routine appointment
- Ankle pain lasting more than 2 to 3 weeks despite rest
- Ankle that keeps giving way after a sprain
- Inner ankle pain with a flattening arch
- Burning or tingling around the inner ankle and sole
Usually safe to manage at home
- A mild sprain where you can walk with some pain and swelling is moderate
- Aching after a long walk or new exercise that improves with rest
Ankle pain causes by location
| Where it hurts | Common causes | Clues |
|---|---|---|
| Outside (lateral) | Sprain, peroneal tendon problems, fibula fracture | Followed rolling the foot inward; swelling under the outer ankle bone |
| Inside (medial) | Posterior tibial tendon dysfunction, tarsal tunnel syndrome, medial sprain | Arch flattening, burning in the sole |
| Front (anterior) | Ankle arthritis, anterior impingement, high ankle sprain | Pain when squatting or climbing stairs |
| Back (posterior) | Achilles tendinitis or rupture, retrocalcaneal bursitis | Stiffness in the morning, tenderness above the heel |
| Whole joint | Arthritis, gout, infection | Swelling, warmth, stiffness |
Outer ankle pain
An ankle sprain causes 85% of ankle injuries. The ligaments on the outside tear when the foot rolls inward. Pain, swelling and bruising appear quickly. A high ankle sprain, affecting the ligaments joining the shin bones, causes pain above the ankle and heals more slowly. Pain behind the outer ankle bone without a sprain suggests peroneal tendinitis.
Inner ankle pain
Posterior tibial tendon dysfunction is the commonest cause of inner ankle pain in adults over 40, especially women. The tendon supporting the arch weakens, causing pain, swelling and gradual flat foot. Tarsal tunnel syndrome compresses the nerve behind the inner ankle bone, causing burning and tingling in the sole.
Back of the ankle
Achilles tendinitis causes pain and stiffness above the heel, worst first thing in the morning and when starting exercise. An Achilles tendon rupture feels like being kicked in the calf, with a pop and weakness pushing off.
Ankle pain without injury
- Gout: sudden, severe pain, redness and swelling, often overnight. It typically affects the big toe but can hit the ankle.
- Osteoarthritis: less common in the ankle than the knee, usually years after a fracture or repeated sprains.
- Rheumatoid and reactive arthritis: swelling of both ankles, morning stiffness.
- Stress fracture: gradual pain after increasing running or marching, with a tender spot on the bone.
- Septic arthritis: a hot, swollen joint with fever. This is an emergency.
- Flat feet and overuse: aching after long periods of standing.
When you need an X-ray
Doctors use the Ottawa ankle rules. An X-ray is needed after an injury if you:
- cannot take 4 steps, both straight after the injury and when examined, or
- have bone tenderness along the back edge or tip of either ankle bone (malleolus), or
- have tenderness at the base of the fifth metatarsal (outer edge of the foot) or the navicular bone (inner midfoot).
Without these signs, a fracture is very unlikely. Ultrasound or MRI is used for tendon tears, persistent pain or suspected cartilage damage.
Treatment and home care
For sprains and strains, in the first 48 to 72 hours:
- Protect and rest the ankle, using crutches or a brace if walking hurts.
- Ice for 15 to 20 minutes every 2 to 3 hours, with a cloth between ice and skin.
- Compress with an elastic bandage, not too tight.
- Elevate the ankle above heart level.
- Pain relief: acetaminophen (paracetamol) or an NSAID such as ibuprofen, following the label dose. Avoid NSAIDs if you have kidney disease, stomach ulcers or take blood thinners.
After 2 to 3 days, start gentle movement and walking as pain allows. Balance and strengthening exercises over 4 to 6 weeks cut the risk of re-injury. A brace or tape during sport helps for several months.
Other treatments depend on the cause: a boot or cast for fractures, physical therapy and orthotics for tendon problems, medicines to lower uric acid for gout, and surgery for severe ligament tears, unstable fractures and tendon ruptures.
Frequently asked questions
What causes ankle pain without injury?
Common causes are tendinitis (Achilles, posterior tibial or peroneal), arthritis, gout, stress fractures and flat feet. A hot, swollen ankle with fever may be an infection and needs urgent care. Pain lasting more than a few weeks should be checked.
How do I know if my ankle is sprained or broken?
You cannot tell reliably by swelling or bruising. A fracture is more likely if you cannot take 4 steps or if pressing the bony edges of the ankle is very tender. If either applies, get an X-ray.
Why does the outside of my ankle hurt?
Outer ankle pain is most often from a past or recent sprain, peroneal tendon inflammation, or ankle instability after repeated sprains. If it follows a fall and you cannot walk, a fibula fracture needs ruling out.
How long does ankle pain take to heal?
A mild sprain usually improves within 1 to 3 weeks. Moderate sprains take 3 to 6 weeks, and severe ones or fractures 6 to 12 weeks or more. Tendon problems often take several months of rehab.
Should I walk on a painful ankle?
After a mild sprain, gentle walking as pain allows usually speeds recovery. Do not walk on it if you cannot take 4 steps, if pain is severe or if a fracture is possible. Use crutches or a brace until you are assessed.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Orthopaedic Surgeons: Sprained ankle; Ankle fractures
- American College of Foot and Ankle Surgeons: Ankle pain
- NHS: Ankle pain
- Ottawa Ankle Rules (Stiell et al., JAMA 1993)
- MedlinePlus: Ankle pain