Ankle Pain: Causes and Treatment Options

Many people experience ankle pain from time to time. Ankle pain can negatively impact your quality of life, especially when it comes to enjoying physical activities, like walking, exercising, and dancing.

There are many different causes of ankle pain, including sprains, arthritis, tendonitis, and more.

The right treatment plan for your ankle pain will vary depending on its cause.

In this article, we’ll cover some of the most common causes of ankle pain and how your provider can help diagnose and treat the condition.

Causes of Ankle Pain

There are many factors that can cause ankle pain, such as injury and certain medical conditions.

Anyone can get ankle pain, but certain people are at a higher risk of developing ankle pain, including:

• Athletes or highly active individuals
• The elderly
• Individuals with a history of ankle injuries or trauma

Ankle sprain

Ankle sprains are one of the most common musculoskeletal injuries and are particularly common among physically active individuals.

Approximately two million ankle sprains occur annually and about half of all patients who sprain their ankle seek out medical care. 

Ankle sprains also have a high recurrence rate, which means that spraining your ankle once puts you at a higher risk of spraining your ankle again at some point in the future.

Ankle sprains happen when the ligaments in the ankle are stretched or torn, which can happen as a result of:

• A fall
• Trauma
• Intense physical activity, such as running, jumping, and playing basketball or volleyball

Pain caused by ankle sprains usually improves within days to weeks, and evidence shows that over-the-counter (OTC) pain relievers, like acetaminophen and ibuprofen, can be more effective than opioids at managing pain.

Data also suggests that up to 70% of people who sustain an ankle sprain may develop residual physical disability, which can include chronic ankle instability.

Ankle strain

A strain is when a muscle or tendon gets twisted, pulled, or torn.

This can happen as a result of playing sports or other physical activities. 

An ankle strain can range from a minor tear to a partial or complete tear of the tendon.

Ankle arthritis

Arthritis describes inflammation or degeneration of one or more joints.

It has many causes, including autoimmune disease, broken bones, infection, and chronic wear and tear. 

There are more than 100 forms of arthritis, many of which can affect the foot and ankle.

The three types of arthritis that most commonly affect the ankle are osteoarthritis, rheumatoid arthritis, and posttraumatic arthritis. 

Rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic autoimmune disease that can affect many different joints throughout the body.

Symptoms of RA most commonly develop between the ages of 40 and 60 and typically begin in the foot and ankle.  

In RA, the immune system attacks its own tissues (including cartilage and ligaments) and softens bone. Specifically, RA causes an overactivity of the lining that lubricates the joints and makes it easier to move.

As the lining becomes inflamed, the joint, ligaments, and other tissues become damaged in the process.

The main symptoms of RA are pain, swelling, and stiffness of the joints.

Unlike osteoarthritis, when RA symptoms occur in the foot and ankle, it usually causes symptoms on both feet and ankles.

Osteoarthritis of the ankle

Osteoarthritis is the most common form of arthritis.

It usually develops slowly and affects middle-aged and older adults, although it can occur in younger individuals, too.

Osteoarthritis describes the wear and tear of cartilage that usually happens over time.

When cartilage wears down, it decreases the protection between bones, which causes pain when bone rubs against bone. 

Though the prevalence of ankle osteoarthritis is unknown, evidence suggests that it ranges from 9%-15% in the general adult population.

Symptoms of osteoarthritis in the ankle usually manifest as pain, stiffness, and inflammation on one ankle that is typically worse in the morning and improves with gentle activity.

Ankle tendonitis

Tendonitis (also referred to as tendinitis) can affect tendons throughout the body.

Tendons are flexible, fibrous structures that connect muscles to bones. When the tendons become inflamed or swollen, it’s called tendinitis. 

Ankle tendonitis can occur from injury, overuse, or aging.

RA and diabetes can also increase the risk of developing tendonitis.

Symptoms of ankle tendonitis include:

• Pain and tenderness along the ankle tendon
• Pain that is worse at night
• Pain that is worse with movement or activity
• Stiffness in the morning

Achilles tendonitis

Achilles tendonitis refers to tendonitis of the Achilles, the largest tendon in the body that connects the heel bone with the calf muscle.

Though the Achilles is strong and can withstand stress from activities like running and jumping, overuse and certain conditions can make some individuals prone to Achilles tendonitis.

Symptoms of Achilles tendonitis include:

• Stiffness or tenderness of the Achilles tendon, especially in the morning
• Ankle and/or heel pain that worsens with activity
• Severe pain the day after exercising
• Heel pain when wearing shoes
• Swelling or inflammation that gets worse throughout the day and with activity
• Thickening of the tendon
• Bone spur formation

Lupus

Lupus is a chronic, autoimmune disease that affects different parts of the body.

Symptoms of lupus can vary widely from person to person, which can make the condition particularly difficult to diagnose.

Possible symptoms of lupus include:

• Muscle and joint pain or swelling (especially of the neck, thighs, shoulders, and upper arms, but it can occur in the feet and ankles, too)
• Fever
• Rashes
• Chest pain
• Hair loss
• Sun or light sensitivity
• Kidney problems
• Recurring mouth sores
• Prolonged or extreme fatigue
• Anemia
• Memory problems
• Lung problems
• Psychosis
• Blood clotting
• Eye disease 

Low arches

Some people are born with low arches or flat feet (also called pes planus), but others can develop flat feet as a result of hereditary conditions, aging, injuries, or illness.

In most cases, low arches do not cause pain or other problems.

But some adults with low arches may experience pain on the outside of the ankle, especially after physical activity or playing sports.

Arch-support orthotics, special shoes, and other stretches can help to alleviate this pain.

Diagnosis

If you’re experiencing ankle pain that’s interfering with your day-to-day life and not getting better on its own, it’s important to reach out to your medical provider for diagnosis.

In order to diagnose the underlying cause, your provider will perform a physical exam and ask about your symptoms and health history.

Additional tests your provider may recommend are:

• X-ray
• MRI
• Blood work

Treatment 

Treatment of your ankle pain will vary depending on the type of ankle pain you have and its underlying cause, which is why consulting with a medical provider is essential to determining the right course of treatment for your symptoms.

Treatment options may include:

• Rest
• Using a bandage or another supportive device around the ankle
• Using crutches or a cane to provide support while walking and moving
• Avoiding putting weight on the ankle as much as possible
• Avoiding sports and other physical activities until your ankle has healed
• Keeping your foot raised above your heart and sleeping with pillows under your ankle
• OTC pain relievers, such as acetaminophen or ibuprofen
• Applying ice (depending on your provider’s recommendations)
• Stretching or agility exercises
• Physical therapy
• Orthotics or shoe inserts
• Wearing well-fitted shoes and avoiding high heels

When to See a Medical Provider

It’s important to reach out to your healthcare provider if you’re experiencing swelling of the ankle that doesn’t go down within two or three days or if you have symptoms of an infection, such as a temperature over 100°F (37.7°C). 

Additional symptoms that warrant emergency medical attention include:

• Ankle or foot that is red, hot, and/or swollen
• Fever
• Fainting
• Chest pain
• Shortness of breath
• Loss of consciousness
• Other severe symptoms

Speaking with a healthcare provider can help you to identify the underlying cause of your leg pain and which treatment options are right for you.

How K Health Can Help

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