Ankle Pain: 3 Causes, Symptoms and Treatment

Ankle pain is something that many people deal with, whether they’re athletes, runners, or just someone who spends a lot of time on their feet.

You will be surprised to learn that ankle sprains are one of the most common injuries people experience. In fact, around 7-10% of all trips to the emergency room are because of ankle sprains¹.

And if you’ve ever sprained your ankle, you know it can keep coming back, leading to a condition known as chronic ankle instability, which affects almost half of those who’ve had a serious ankle injury².

As a physiotherapist in Sandton, my goal is to help you understand what’s going on with your ankle and how you can take steps to keep it strong and pain-free.

What causes Ankle Pain?

Ankle pain can come from several different structures, but most often it involves the tendons, ligaments, or the joint itself. These parts work together to support movement, absorb stress, and keep you balanced. When one of them is injured or irritated, pain is usually the first sign that something’s wrong.

Tendons

Tendons connect muscles to bones and help move your foot and ankle. If they become overloaded, inflamed, or torn, they can cause sharp or burning pain—especially during activity. Common issues include:

• Tendinopathy – wear and tear from overuse or poor mechanics
• Tendon tears or ruptures – often from sudden force or repeated strain

Ligaments

Ligaments are strong bands of tissue that connect bone to bone. They stabilize the ankle and prevent it from giving way. Injuries here often happen suddenly, like when the ankle rolls or twists. These include:

• Sprains – stretching or tearing of ligaments, usually on the outer side of the ankle
• Chronic instability – ongoing weakness after repeated sprains

The Ankle Joint

The ankle joint is where the shin bone (tibia), the smaller leg bone (fibula), and the ankle bone (talus) meet. It’s lined with cartilage and supported by synovial fluid to allow smooth, pain-free movement. When this joint becomes damaged, you may feel deep, aching pain or stiffness. Causes include:

• Osteoarthritis – gradual breakdown of cartilage over time
• Post-traumatic arthritis – joint damage after previous injury

Who is at Risk for Ankle Pain?

Ankle problems are more likely if you:

• Play high-impact sports or run frequently
• Have a history of ankle injuries
• Stand or walk for long periods on hard surfaces
• Are older and experiencing joint or tissue wear

What are Common Symptoms of Ankle Pain?

1. Swelling: Your ankle will look puffy or feel tight, especially after you’ve been on your feet for a while.
2. Bruising: You will notice dark blue or purple marks around your ankle, which usually show up after a sprain.
3. Stiffness: Moving your ankle will feel difficult, especially in the morning or after resting.
4. Pain when walking: You could feel a sharp or throbbing pain when you put weight on your ankle, making it hard to walk normally.
5. Tenderness: Your ankle will be sensitive to touch, especially around the sides or the front of the joint.
6. Instability: It will feel like your ankle is going to give out or collapse when you’re walking or running.
7. Difficulty standing on tiptoes: You will struggle to stand on your toes or feel pain when trying to do so.
8. Clicking or popping sounds: Sometimes, you will hear or feel a popping or clicking noise when you move your ankle.
9. Warmth: The skin around your ankle will feel warmer than usual, especially if there’s inflammation.
10. Pain at rest: Even when you’re not moving, your ankle will still hurt, especially if it’s been injured multiple times.

Why Does Ankle Pain Happen?

Ankle pain happens because of problems with the parts inside the ankle joint. To really understand why your ankle hurts, it’s important to know how these parts work together and what can go wrong.

This section will explain what the ankle is made of, how injuries happen, and how your body responds when things go wrong.

How the Ankle Works

The ankle is where your foot connects to your leg. It’s made up of three main bones: the tibia (the big bone in your lower leg), the fibula (the smaller bone next to the tibia), and the talus (a bone that sits above your heel). These bones are held together by ligaments, tendons, and muscles.

Ligaments

Ligaments are strong bands that hold the bones together and keep the ankle stable. The main ligaments are on the sides of the ankle, helping to prevent it from turning too far in or out.

Tendons

Tendons are like ropes that connect your muscles to your bones. When the muscles tighten, they pull on the tendons, which then move your bones. In your ankle, the Achilles tendon is one of the most important because it helps you push off the ground when you walk or run.

Muscles

The muscles around your ankle help you move your foot and keep your ankle steady. They’re important for both walking and standing.

How Ankle Injuries Happen

Ankle pain usually starts with an injury or from using your ankle too much over time. Here’s what typically goes wrong:

Twisting the Ankle

A common way people hurt their ankle is by twisting it, like when you step on something uneven or land awkwardly after a jump. This can stretch or tear the ligaments, leading to pain and swelling.

Overuse

If you’re always on your feet or do a lot of physical activity, the constant strain can wear down the tendons and muscles around your ankle. This can cause pain and make your ankle feel weak.

Impact

Sometimes, a direct hit to the ankle, like from a fall or a sports injury, can damage the bones or other tissues in the joint.

When you injure your ankle, your body reacts in a few ways:

• Swelling: Fluid builds up around the injury to protect the area, but it can also cause pain and stiffness.
• Pain: Pain is your body’s way of telling you something is wrong. It can come from inflammation, where your body sends extra blood to the injured area to help it heal.
• Stiffness: After an injury, the muscles and tendons around the ankle will tighten up to keep the joint from moving too much. This can make it hard to move your ankle normally.

What Conditions Cause Ankle Pain?

1. Ankle Sprain: This happens when the ligaments (the bands of tissue that hold your ankle bones together) are stretched or torn, usually from twisting your ankle the wrong way. It’s the most common cause of ankle pain.
2. Chronic Ankle Instability (CAI): If you have sprained your ankle a few times, you will develop this condition, where your ankle feels weak and will give out when you’re walking or running.
3. Ankle Fracture: This is a break in one of the bones in your ankle, usually from a bad fall or direct hit.
4. Tendinopathy: This is when the tendons (the cords that connect muscles to bones) around your ankle get inflamed from overuse. Common types include Achilles Tendinopathy and Peroneal Tendinopathy.
5. Osteoarthritis: This is a condition where the cartilage in your ankle joint wears down over time, causing pain, stiffness, and swelling.
6. Gout: A type of arthritis caused by a buildup of uric acid crystals in your ankle joint, leading to sudden, sharp pain, usually with redness and swelling.
7. Rheumatoid Arthritis: An autoimmune disease where your immune system attacks your joints, including the ankle, causing pain, swelling, and stiffness.
8. Posterior Tibial Tendon Dysfunction (PTTD): This happens when the tendon that supports the arch of your foot gets inflamed or torn, causing pain on the inside of your ankle and foot.
9. Achilles Tendon Rupture: A complete tear of the Achilles tendon, often from sudden movements like running or jumping, leading to severe pain and difficulty walking.
10. Tarsal Tunnel Syndrome: This is caused by pressure on the tibial nerve as it passes through the tarsal tunnel near your ankle, leading to pain, tingling, or numbness in your foot and ankle.
11. Stress Fracture: A small crack in the bone from repeated stress or overuse, often seen in athletes or people who do a lot of physical activity.
12. Bursitis: Inflammation of the small fluid-filled sacs (bursae) around the ankle joint, usually from overuse or prolonged pressure.
13. Nerve Entrapment: This is when nerves around your ankle get pinched or irritated, causing pain, numbness, or tingling.
14. Osteochondral Lesion: This is when a piece of cartilage or bone in your ankle joint gets damaged, causing pain, swelling, and making your joint feel unstable.

What Are Some Mistakes People Make When They Have Ankle Pain?

Not Resting Enough

One of the biggest mistakes is trying to keep going even when your ankle hurts. Whether it’s because you don’t want to miss out on activities or you think the pain will go away on its own, not resting can make things worse.

Not Doing Rehab Exercises

After the pain starts to ease up, many people skip physical therapy or don’t do their rehab exercises. This can leave your ankle weak and more likely to get injured again.

Returning to Activity Too Soon

Getting back to sports or heavy activity before your ankle is fully healed can cause re-injury. This not only sets you back but can also lead to long-term issues like chronic pain or instability.

Ignoring Ongoing Symptoms

If your ankle keeps hurting or feels unstable, it’s a sign that something isn’t right. Ignoring these symptoms can make the problem worse and harder to fix later on.

What Happens if You Ignore Ankle Pain?

Chronic Ankle Instability

If you don’t let your ankle heal properly after an injury, it can lead to chronic instability. This means your ankle will feel weak and give out easily, making it hard to walk or do activities without worrying about it giving way.

Permanent Joint Damage

Not treating ankle pain can cause lasting damage to the bones, cartilage, and ligaments in your ankle. This can lead to arthritis, where your joint becomes painful and stiff over time.

Reduced Mobility

If your ankle pain goes untreated, it can become harder to move around. Walking, running, or even standing for long periods will become painful or impossible.

Increased Risk of Falls

An unstable ankle makes you more likely to trip or fall, which can cause other injuries, like fractures or sprains in other parts of your body.

Other Body Problems

If you start limping or changing the way you walk because of ankle pain, it can cause problems in other parts of your body, like your knees, hips, or back.

What Can You Expect From Ankle Pain?

The good news is that with the right care, most people can recover fully from ankle pain. Relative rest, physiotherapy, and sometimes medication or a brace can help your ankle heal and get stronger. If you take care of it early, you’re likely to get back to your normal activities without any long-term issues.

However, if you ignore the pain or don’t treat it properly, the outlook isn’t as good. You might end up with chronic problems like ongoing pain, instability, or even arthritis, which can be harder to treat and might limit what you can do in the future.

In some cases, surgery might be needed, and recovery could take much longer, with no guarantee that your ankle will ever be as strong as it was before.

Treatment Options for Ankle Pain

When it comes to treating ankle pain, physical therapy offers several effective options that can help relieve your pain, improve your movement, and prevent further injury. Here’s a breakdown of the treatment methods I can provide, along with some advice on how each can help you recover.

Myofascial Release

Myofascial release is a hands-on technique that involves applying gentle pressure to the fascia, the connective tissue surrounding your muscles. This can help reduce tension, improve blood flow, and increase your range of motion. If you’re experiencing tightness or stiffness in your ankle, myofascial release can be very effective in easing these symptoms³.

Orthopedic Manual Therapy

Orthopedic manual therapy involves specific hands-on techniques to help your ankle move better and feel less painful. This can include joint mobilizations, where I gently move your ankle in specific ways to restore proper alignment and function. This approach is particularly useful if your ankle feels stiff or if you’ve lost some mobility after an injury³.

Laser Therapy

Laser therapy uses light energy to help reduce inflammation and promote healing in your ankle. It’s a painless treatment that can speed up recovery, especially if you’re dealing with swelling or a recent injury. Laser therapy can be a great way to manage pain and improve your ankle’s healing process⁴.

Dry Needling

Dry needling involves inserting very thin needles into tight or painful muscles around your ankle. This helps to release tension, improve muscle function, and reduce pain. It’s similar to acupuncture but focuses more on treating muscle knots and tight spots that might be contributing to your ankle pain⁴.

Strapping and Taping

Strapping or taping your ankle provides extra support, which can be especially helpful if your ankle feels unstable or weak. This can prevent further injury by keeping your ankle steady, particularly during activities like walking or sports. Taping can also help reduce pain and swelling by providing gentle compression⁵.

Exercise Therapy

Exercise is a crucial part of your recovery, helping to strengthen your ankle, improve flexibility, and restore normal function. Here are the main types of exercises we’ll focus on:

• Range of Motion Exercises: These exercises are designed to gently restore movement in your ankle. If your ankle feels stiff, we’ll work on simple exercises like ankle circles or pointing and flexing your foot to help get your range of motion back.
• Strengthening Exercises: Strengthening the muscles around your ankle is key to supporting the joint and preventing future injuries. Exercises like calf raises or using resistance bands can help build up strength in your ankle and foot muscles.
• Balance and Stability Exercises: Improving your balance and stability is important, especially if you’ve had a sprain or other injury. Exercises like standing on one foot or using a balance board can help make your ankle more stable and reduce the risk of re-injury.
• Stretching Exercises: Stretching helps keep your muscles flexible and can reduce pain. We’ll focus on stretches for your calf muscles and Achilles tendon, which are important for overall ankle health.

Conclusion

As your physiotherapist, I want you to know that overcoming ankle pain is absolutely possible. I’ve worked with many people who started out feeling stuck by their ankle pain, but by sticking to their treatment, they’ve regained their strength and confidence.

Ankle pain is tough, but it doesn’t have to control your life. We’ve explored a variety of treatments, from exercises that build strength and flexibility to therapies like taping and dry needling that can give relief.

If you ever need anything, know that I’m here for you, ready to help you every step of the way.

About the Author

Daniel da Cruz is a licensed physiotherapist in Sandton, Johannesburg, with a special focus on ankle and foot injuries—from acute sprains and chronic ankle instability to Achilles and peroneal tendinopathies.

He combines evidence-based exercise rehab, hands-on treatment, and education to reduce pain, restore stability, and help patients return to sport, work, and daily life with confidence.

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References

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2. Attenborough, A. S., Hiller, C. E., Smith, R. M., Stuelcken, M., Greene, A., & Sinclair, P. J. (2014). Chronic ankle instability in sporting populations. Sports medicine (Auckland, N.Z.), 44(11), 1545–1556. https://doi.org/10.1007/s40279-014-0218-2
3. Rodriguez-Merchan E. C. (2012). Chronic ankle instability: diagnosis and treatment. Archives of orthopaedic and trauma surgery, 132(2), 211–219. https://doi.org/10.1007/s00402-011-1421-3
4. Wang, J., Liu, G. T., Mayo, H. G., & Joshi, G. P. (2015). Pain Management for Elective Foot and Ankle Surgery: A Systematic Review of Randomized Controlled Trials. The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons, 54(4), 625–635. https://doi.org/10.1053/j.jfas.2014.05.003
5. Doherty, C., Bleakley, C., Delahunt, E., & Holden, S. (2017). Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis. British journal of sports medicine, 51(2), 113–125. https://doi.org/10.1136/bjsports-2016-096178