Causes of Ankle Pain

What is the ankle?

The ankle is a joint connecting the lower leg and foot. The upper ankle consists of three bones; tibia (shin-bone), fibula (calf bone), and talus (ankle bone). It allows the foot to move up, down and sideways. The lower ankle connects the talus to the calcaneus (heel bone) and the tarsus (midfoot and hindfoot). This part of the ankle has less movement than the upper ankle, but can tilt side to side and turn inward and outward. Click here to view the ankle structure.

Ankle pain may result from trauma or injury to the ankle bones, ligaments or tendons. Other various conditions can also cause ankle pain.

Achilles tendinitis

The Achilles tendon is tissue that connects the calf muscle to the heel bone in the lower back leg. Achilles tendinitis is the result of an injury to the tendon. It often occurs when runners increase duration and intensity or when middle-aged people play sports.

Symptoms include the following:

• Ankle swelling
• Tenderness
• Stiffness
• Mild pain in the back of the leg and upper heel

Achilles tendon rupture

If the Achilles tendon is overstretched, it can rupture or tear. Immediate symptoms include the sound of a “pop,” followed by sharp pain in the back of the ankle and lower leg. It affects the ability to walk correctly.

Symptoms include the following:

• Pain and swelling near the heel
• Calf pain
• Inability to bend the foot forward
• Not able to stand on the toes of the injured leg

Ankle bursitis

Bursae are small, fluid-filled sacs that act as a cushion to reduce friction between the bones, tendons and muscles that are located near joints. In the ankle, it is located between the calcaneus (heel bone) and the Achilles tendon, called the retrocalcaneal bursa. Ankle bursitis occurs when the bursa becomes inflamed. Inflammation may emerge from arthritis, shoes, overuse, beginning new workouts, previous or current injury, etc. Stress on the ankle can sometimes cause additional bursa to form.

Symptoms include the following:

• Heel pain or swelling
• Pain when pressure is applied to the back of the heel or when flexing the foot
• Pain when standing on the tiptoes
• Limping to avoid putting weight on the ankle
• Redness
• Fever or chills (if infected)

Ankle fracture

An ankle fracture ensues if a bone in the ankle (talus, tibia, or fibula) breaks, chips or cracks. Exposed bone may appear in severe cases.

Symptoms include the following:

• Pain
• Swelling
• Bruising
• Bone deformities
• Numbness
• Inability to move the toes

Ankle sprain

An ankle sprain results from torn or stretched ligaments. This often stems from rolling the foot sideways. Depending on the severity of the injury, it can take a few days to a few months to heal.

Symptoms include the following:

• Bruising
• Swelling
• Inability to bear weight

Arthritis

Many forms of arthritis can cause pain, swelling and stiffness in the ankles. Osteoarthritis (OA), one of the most common forms of arthritis, is a joint condition that involves the gradual breakdown of cartilage in one or more joints. When the protective cushioning of cartilage deteriorates, the bones in the joint eventually rub together, causing inflammation and pain.

Rheumatoid arthritis (RA) is a chronic, inflammatory autoimmune disorder in which the body's immune system mistakenly attacks the body's own tissues. RA can affect any joint in the body, including ankle joints.

Reactive arthritis involves joint inflammation and pain triggered by an infection in a different part of the body. Pain and swelling can impact the ankles.

Psoriatic arthritis (PsA) is a form of inflammatory arthritis that can occur with the skin condition, psoriasis. PsA is a combination of the joint problems of arthritis and the skin issues of psoriasis.

Gout

Gout is a complex form of arthritis that can develop when the blood contains high levels of uric acid. If the body produces too much uric acid or the kidneys excrete too little uric acid, it can build up in the blood and form sharp urate crystals in or around specific joints, including the big toe or ankle. Symptoms include swelling and rapid onset of severe pain.

Avascular necrosis

Avascular necrosis is a medical condition that occurs when the blood supply to a bone is reduced or interrupted. Without an adequate supply of blood, the tissue in the bone dies. As a result, tiny breaks appear, which can lead to the eventual collapse of the bone. If avascular necrosis develops in a bone near a joint, the joint surface may also collapse. Pain in the affected joint is frequently the only symptom.

Broken Foot

A broken foot results from an injury, causing pain in the ankle. Fractures can range from small cracks to breaks that pierce the skin.

Symptoms include the following:

• Pain or tenderness
• Swelling
• Bruising
• Deformity
• Difficulty walking or bearing weight

Fibular avulsion fracture

An avulsion fracture derives from a ligament or tendon pulling off part of the bone. A fibular avulsion fracture is typically caused by a sudden rolling inward of the foot. This places too much stress on a ligament, causing it to tug off a small piece of the fibula. It feels similar to a severe ankle strain, making walking impossible until it heals.

Flat Feet

Flat feet or flat foot occur when arches do not develop or collapse. No arch can be seen when standing on the feet. It can be genetic or develop over time.

Symptoms include the following:

• Pain in the ankle, arch, heel, or outside the foot
• Leg cramps
• Muscle pain in the leg or foot
• Pain when walking or changing gait
• Toe drift

Osteochondritis dissecans

Osteochondritis dissecans is a joint disease causing a layer of bone under the cartilage to die due to lack of blood supply. The dead bone and cartilage can break loose.

Symptoms include the following:

• Pain
• Swelling
• Tenderness
• Joint weakness, locking or popping
• Decreased range of motion

Osteochondral lesions

A traumatic injury can produce cartilage damage or bone fractures to the talus, resulting in an osteochondral lesion. This may be due to a severe ankle sprain or an overload from misalignment or instability of the ankle joint. Oftentimes, it happens with no pain or swelling and is found by imaging.

Symptoms include the following:

• Pain that worsens when walking, running or jumping
• Clicking or popping sounds

Plantar fasciitis

The plantar fascia is a thick band of tissue reaching from the heel to the front of the foot; it supports the arch of the foot and acts as a shock absorber. If this tissue gets stretched too far, it causes tiny tears and inflammation that result in heel pain; this is referred to as plantar fasciitis. While the pain is mainly in the foot, it can radiate to the ankle if a nerve is irritated.

Symptoms of plantar fasciitis include the following:

• Stabbing pain with the first few steps upon awakening
• Pain that worsens after standing for long periods or physical activity
• Heel pain or stiffness
• Discomfort that eases with gentle movement
• Pain in the arch
• Swollen heel
• Pain lasting months
• Tight Achilles tendon

Stress fracture

Stress fractures appear as tiny cracks in the bone. They can result from repetitive force, overuse, or osteoporosis. Pain may worsen over time. The injured area may be tender and swollen, but improve with rest.

Tarsal tunnel syndrome

Tarsal tunnel syndrome (TTS) results from tibial nerve damage. The tibial nerve goes through the tarsal tunnel, which is located inside the ankle. The tarsal tunnel is composed of ankle bone and ligaments.

Symptoms may worsen following physical activity and include the following:

• Pain, numbness and weakness in the feet
• Pain inside the ankle
• Burning
• Pins and needles sensation

Additional source: Massachusetts General Hospital