Ankle pain

What are the common causes of ankle pain?

The ankle joint is where your two shin bones, the tibia and fibula, meet your foot bone, the talus. Pain here is often linked to an injury, but it doesn't have to be. Injury-related causes include:

• a sprain, where a ligament is over-stretched or torn during a twist or a fall
• a fracture, a break in one of the ankle bones, usually after a heavy knock or a fall
• tendinopathy, where a tendon becomes painful and stiff from ongoing strain
• bursitis, swelling in one of the small fluid-filled cushions that protect the joint.

Ankle pain can also build up gradually, without any obvious injury, because of:

• osteoarthritis, general wear and tear in the joint
• rheumatoid arthritis or lupus, conditions where the immune system attacks the body's own tissue
• gout, a build-up of crystals in the joint that brings on sudden, severe pain
• a trapped or irritated nerve close to the ankle
• an infection in the joint or in the bone around it.

Exercising more than you're used to, or wearing shoes that don't fit well, can also bring on ankle pain.

Are there different types of ankle pain?

Ankle pain tends to be grouped by its cause rather than by how it feels:

• Tendon problems: Achilles tendinopathy causes pain and stiffness where the tendon meets the heel; tibialis posterior dysfunction causes pain on the inside of the ankle; and peroneal tendinopathy causes pain on the outer side
• Joint conditions: This includes osteoarthritis, rheumatoid arthritis and gout
• Nerve problems: Such as tarsal tunnel syndrome, or a trapped nerve close to the ankle
• Injuries: For example sprains and fractures
• Infections: In the joint itself, or in the surrounding bone.

How is ankle pain diagnosed?

A GP or physiotherapist will usually start by examining your ankle, checking its range of movement and looking for swelling or signs of infection. If more information is needed, they may suggest:

• an X-ray, to look for fractures, bone spurs or cartilage loss
• an ultrasound scan, to check for tendon damage
• an MRI scan, to check for ligament damage
• a CT scan, to get a closer look at the joint or bone.

If you already have a condition such as rheumatoid arthritis or lupus, mentioning this, along with any previous episodes of joint pain, can help your GP work out what's behind your current symptoms.

How is ankle pain treated?

For minor injuries, home treatment is often enough to begin with. Try to:

• rest the joint and avoid whatever activity brought on the pain
• cool the area with an ice pack, or a bag of frozen peas over a thin cloth, to help bring down swelling
• support your ankle with a bandage
• rest your foot on a cushion so it sits higher than your heart
• take paracetamol or ibuprofen, or use ibuprofen gel, for pain and swelling*
• choose roomy, comfortable footwear with a flat sole and a low heel while you recover

Try to avoid standing or walking for long stretches, and steer clear of high heels or narrow, pointed shoes until symptoms ease. * Ibuprofen should always be taken with food and only if it doesn’t interact with any other medicines you take. Don’t use both ibuprofen gel and ibuprofen tablets at the same time. Seek a medical review if you get indigestion or side effects. If home treatment doesn't help, a GP or physiotherapist may offer:

• physiotherapy, combining hands-on treatment with exercises to rebuild strength and balance
• anti-inflammatory medicines, or a steroid injection for more severe swelling
• a splint, brace or cast to support the ankle while it heals
• surgery, for severe tears, fractures, or arthritis that hasn't responded to other treatment.

When should I see a doctor?

See a GP if:

• ankle pain is stopping you getting on with your normal day
• the pain keeps coming back, or is getting worse rather than better
• the pain hasn't eased after two weeks of home treatment
• you notice tingling, or a loss of feeling, in your foot
• you have diabetes and any foot pain, as this needs closer attention
• your ankle becomes warm, discoloured or increasingly swollen, which can point to infection
• you feel generally unwell alongside the pain, with a fever, night sweats or unexplained weight loss.

Call NHS 111, or go to A&E, if:

• the pain is severe
• you feel faint, dizzy or sick because of the pain
• your ankle or foot looks a different shape, or sits at an odd angle
• you heard or felt a pop, a grinding sensation, or a snap when you were injured
• you can't put any weight on the foot at all.

These can be signs of a broken bone or a serious infection.