Ankle pain can be caused by many things, including sprains, tendonitis, an abnormal gait, trauma, fractures, rheumatoid arthritis, or tarsal tunnel syndrome.

Ankle pain can be severe and/or sudden and may be accompanied by difficulty moving the foot, walking, or climbing stairs, which can interfere with activities of daily living.

It is important to consult an orthopedic specialist or your primary care provider if you are experiencing ankle pain so that the underlying cause can be identified and treated appropriately. Severe ankle pain caused by trauma, for example, needs to be evaluated in the emergency department.

female health care provider extending the leg of a female patient who is seated

Common causes

The main causes of ankle pain are:

1. Fractures

An ankle fracture can cause severe pain in the affected ankle.

Other symptoms include localized swelling and deformity, inability to move the foot, bruising, numbness, and tingling.

What to do: Ankle fractures need to be evaluated in the emergency department. Treatment is managed by an orthopedic surgeon and involves immobilizing the ankle and administering medications like analgesics and anti-inflammatories, followed by physical therapy.

2. Abnormal gait

Gait abnormalities, like walking on the outside part of the foot (supinated gait) or the inside part of the foot (pronated gait) can lead to ankle pain.

An abnormal gait can cause pain by putting too much stress on the ankle or other parts of the foot, such as the heel, toes, or soles.

What to do: An orthopedic specialist can identify the type of abnormal gait and arrange for the most appropriate treatment, which usually involves global postural re-education (GPR) with exercises to correct the gait.

3. Ankle sprain

An ankle sprain is the rupture or stretching of the anterior or posterior talofibular and/or calcaneofibular ligaments, resulting in ankle pain and swelling.

Other symptoms of an ankle sprain include difficulty moving the foot or putting weight on it or a feeling of instability in the ankle.

What to do: Ankle sprains should be evaluated at an urgent care or emergency department and typically require a consult with an orthopedic specialist. Sprained ankle treatment involves rest, applying cold compresses during the first 48 hours, and the use of anti-inflammatories for pain relief.

Treatment may also involve immobilizing the ankle with an ACE bandage, orthopedic boot, or cast as well as a referral to physical therapy. Surgery may be recommended in the most severe cases.

4. Achilles tendonitis

Achilles tendonitis is inflammation of the Achilles tendon (calcaneal tendon), which is located in the heel and connects the heel bone to the calf muscle.

This inflammation can cause pain in the back of the ankle, a burning sensation, or stiffness in the ankle and heel that worsens with activity and is more common first thing in the morning.

Achilles tendonitis is typically caused by repetitive stress on the tendon and is common in runners, however it can also be caused by weight gain or stiffness of the calf muscles.

What to do: It is important to rest the heel and ankle and avoid repetitive movements in order to reduce inflammation and relieve pain and discomfort. You can also apply a cold pack daily.

In some cases, an orthopedic specialist may recommend physical therapy, particularly in cases of frequent flare ups or inflammation that does not go away over time. Anti-inflammatory medications or surgery may also be recommended.

5. Stress fractures

A stress fracture of the ankle is a small crack or microfracture in the bones of the ankle, such as the fibula, tibia, or talus. Symptoms of a stress fracture include pain that gets progressively worse, swelling, and pain at rest.

This type of fracture is typically related to overuse of the joint due to sports like running or track and field.

What to do: Treating a stress fracture involves taking a break from exercise, resting the ankle, and applying cold compresses for 10 minutes at a time.

Stress fractures should also be evaluated by an orthopedic specialist, who may recommend immobilizing the ankle with an orthopedic boot or cast, or the use of medications to relieve pain and swelling.

6. Tarsal tunnel syndrome

Tarsal tunnel syndrome involves compression of the nerve that passes through the ankle and the sole of foot. It may be caused by fractures, sprains, diabetes, rheumatoid arthritis, or gout.

This condition causes pain and burning in the ankle as well as a tingling sensation of the inner side of the foot toward the back that typically worsens with weight-bearing activities and improves with rest.

What to do: The goal of treatment is to decompress the nerve and relieve symptoms. To do this, an orthopedic specialist may recommend immobilization, anti-inflammatories, physical therapy, or even surgery.

7. Osteoarthritis

Osteoarthritis of the ankle is characterized by degeneration of the cartilage of the upper part of the talus, reducing the quality, quantity, and thickness of the cartilage and resulting in chronic ankle pain.

This degeneration can cause ankle stiffness in the morning or difficulty walking.

What to do: It is important to consult an orthopedic specialist for treatment with analgesics or anti-inflammatories to relieve the pain.

Physical therapy is also recommended for management of osteoarthritis. Your provider may also recommend corticosteroid injections into the affected ankle in some cases.

8. Ankle bursitis

Ankle bursitis is an inflammation of the retrocalcaneal bursa, a small fluid-filled sac located between the heel bone and the Achilles tendon that acts as a cushion to absorb shock.

This inflammation causes pain in the back of the ankle as well as redness, swelling, and a burning sensation.

Ankle bursitis is typically caused by excessive or repetitive ankle movements and is more common in athletes, however it can also occur as a result of gout or rheumatoid arthritis.

What to do: In the case of ankle bursitis, an orthopedic specialist may recommend anti-inflammatories, cold compresses, cutting back on workouts, physical therapy sessions, stretches, and different types of exercise.

Learn more about bursitis treatment.

9. Gout

Gout is an accumulation of uric acid in the joints that can affect the toes, tops of the feet, and ankles.

This condition causes ankle pain and swelling in addition to redness of the skin and the formation of small crystals in the joints of the ankles and/or feet.

What to do: It is important to consult an orthopedic specialist or rheumatologist for the most appropriate treatment, which may involve the use of medications like allopurinol, probenecid, or colchicine that help lower uric acid levels to reduce pain and swelling.

It is also recommended to avoid foods that are high in uric acid by following a special gout diet.

10. Traumatic injury

A traumatic ankle injury may be the result of a fall, contusion, blow, torsion (twisted ankle), dislocation, or fracture.

These cases involve severe ankle pain that comes on suddenly and is accompanied by swelling and difficulty moving the foot.

What to do: Traumatic injuries that do not involve a fracture can be managed with rest and by applying cold packs two to three times a day for 15 minutes at a time.

A fracture or dislocation requires evaluation and treatment in the emergency department. Physical therapy may also be recommended to help with pain relief, even in mild cases.

11. Torn ligament

A torn ligament in the ankle can cause ankle pain and decreased range of motion. These ligaments include the anterior and posterior talofibular ligaments and the calcaneofibular ligament.

It is common to hear or feel a sudden snap prior to the onset of symptoms, or to feel like the ankle is frozen or stuck.

A torn ligament in the ankle is more likely to occur due to a sudden forceful movement during sports like soccer, basketball, or tennis.

What to do: Treatment of a torn ligament is managed by an orthopedic specialist and generally involves surgery followed by months of physical therapy and resting the ankle. An ankle brace may be required initially to immobilize the ankle.

12. Rheumatoid arthritis

Rheumatoid arthritis is a chronic, inflammatory autoimmune disorder that causes pain, stiffness, and swelling of the joints.

This condition can affect day-to-day life and cause difficulties walking and climbing stairs, for example.

What to do: An orthopedic specialist or rheumatologist may prescribe analgesics and anti-inflammatories to help manage rheumatoid arthritis, in addition to physical therapy to improve range of motion.

13. Bone marrow edema

Bone marrow edema is a buildup of fluid in the bone marrow that typically affects the lower limbs, causing ankle pain, stiffness, swelling, and warmth over the area.

Pain associated with bone marrow edema typically worsens with walking and may be caused by trauma, accidents, falls, or sports.

What to do: It is important to consult an orthopedic specialist in order to confirm the diagnosis of bone marrow edema, which is usually done with an MRI (magnetic ressonance imaging). Treatment involves rest, pain medications, the use of crutches, and, in some cases, surgery.