Home / Conditions / Ankle pain
Most ankle pain starts with a twist, and most of it settles. The ones that matter are the sprain that never quite recovered and the pain that arrived without an injury at all.
| After a twist or a fall | Without an injury | |
|---|---|---|
| Usual causes | Ligament sprain, fracture, tendon tear, cartilage damage inside the joint | Tendon problems, arthritis, gout, nerve compression |
| Swelling | Immediate, often with bruising | Gradual, worse through the day |
| Weight bearing | Often difficult at first | Usually possible, but sore |
| What to do first | An X-ray if you cannot walk on it, or it is tender over bone | Examination; imaging only if it changes the plan |
Not every twisted ankle needs an X-ray. It is worth one if you could not take four steps at the time or since, or if pressing on the bone at the back of either ankle bone is sharply painful. Otherwise a sprain is treated on its behaviour, not its pictures.
The anterior talofibular ligament — the one running forwards from the outer ankle bone towards the front — is the ligament that tears in a classic rolled ankle. The calcaneofibular ligament below it is the next to go when the sprain is more severe.
Behind, the Achilles tendon attaches to the heel bone. Those two areas, the outer ligaments and the tendon behind, account for most of the ankle pain we see.
Most sprains are comfortable within a few weeks — see ankle sprain for grades, recovery times and rehabilitation. When one is still painful or swollen at six weeks, the usual reason is that something else happened at the same time.
Repeated sprains are not bad luck. Each one stretches the ligaments further, and an ankle that gives way regularly is worth assessing, because instability is treatable and the wear it causes is not.
Go to an emergency department if the ankle looks deformed, you cannot bear weight at all after an injury, or the foot is cold, pale or numb.
The same day for a hot, red, swollen ankle with fever, or a sudden snap at the back of the ankle with difficulty pushing off.
Almost all ankle problems are treated without surgery. What differs is the rehabilitation, and in particular how soon it starts.
Relative rest, ice, and support. Weight through the ankle as comfort allows rather than complete rest, since early movement produces a better result than prolonged immobilisation.
Strength and balance work is the treatment for a sprain, not an optional extra. It is what prevents the next one, and skipping it is the commonest reason ankles keep rolling.
A brace for sport while ligaments recover, insoles where the arch or alignment is part of the problem, and a guided injection in selected cases.
Fractures that need fixing, ligament reconstruction for an ankle that keeps giving way, keyhole surgery for cartilage damage or impingement, and tendon repair where one has torn.
Ankle problems here are seen by Dr Jeffrey Tan Gek Meng, an orthopaedic surgeon whose subspecialty is foot and ankle. He also treats sports injuries and lower limb trauma, and consults in English, Mandarin and Hokkien.
Not always. It is worth one if you could not take four steps at the time or since, or if pressing on the bone at the back of either ankle bone is sharply painful. Otherwise the ankle is assessed on how it behaves.
Most are much better within two to six weeks, though full confidence on uneven ground can take longer. Still painful or swollen at six weeks is a reason to be seen.
No. Early movement and weight within comfort produce a better result than prolonged rest, and balance work is what stops it happening again.
It is common, but it is not something to accept. Repeated giving way suggests the ligaments healed loose, and that is treatable.
Yes. Tendon problems, arthritis, gout and nerve compression all cause ankle pain with no trauma at all, and each is treated differently.
No. Bring any X-ray or scan reports, and be ready to describe how the injury happened.
Gout · Knee pain · Nerve and leg pain · Osteoporosis · Rhabdomyolysis
Bring the story of how it happened, and how many times. A sprain that keeps returning is a different problem from a first one.
