Ankle pain

What is ankle pain, and how common is it?

Ankle pain is a symptom with many possible causes, not one condition. It's very common and can happen at any age. It can be strong, but it's usually not caused by serious damage¹. About 15% of adults aged 45 and over have frequent ankle pain². Sprains are among the most common injuries to muscles, bones and joints³, and many people who sprain an ankle go on to have ongoing problems⁴.

What can cause ankle pain?

After an injury or fall, ankle pain is often from a sprain or strain, or a broken bone or stress fracture (a small crack in a bone)⁵. Pain that builds up gradually can come from arthritis, osteoarthritis (wear in the joint) or tendinitis (an irritated tendon)⁵, or from overuse, such as Achilles tendinopathy (a sore tendon at the back of the ankle)¹. Too much exercise or tight shoes are common triggers⁶.

Most sprains involve the ligaments (strong bands that hold the joint together) on the outer side of the ankle⁷. The causes can feel alike, so it's hard to tell them apart yourself. Noting how the pain started, where it is and what eases or worsens it helps your podiatrist, physiotherapist or GP narrow it down.

How is the cause of ankle pain found?

A podiatrist, physiotherapist or GP will ask how it happened, whether you could put weight on it straight away and where it's tender, then examine the ankle. After an injury, pain and swelling can limit the first check, so you may be examined again a few days later, when ligament damage is easier to judge⁴.

You don't need an X-ray for every sprain⁸. Set checks called the Ottawa ankle rules help decide whether one is needed to look for a break⁴. Ultrasound can show a fresh ligament injury⁹, and MRI is kept for suspected serious injuries or symptoms that don't settle⁴. With no recent injury, diagnosis rests mainly on your history and examination, and scans come second¹⁰.

What can I do first?

For most sprains, staying active works better than complete rest¹¹. Start walking and stretching as soon as you can manage it⁵, adjusting what you do at first rather than stopping completely¹. Exercises started early can reduce repeat injuries⁴.

A real ankle brace or tape supports an ankle better than a simple compression bandage⁴. A short time in a cast or rigid support (under 10 days) can ease pain and swelling, but four weeks or more gives poorer results than support and exercise⁴. A more complex sprain may need a boot or cast⁵.

Anti-inflammatory medicines can ease short-term pain after a sprain, but they have complications and may slow natural healing, so ask your GP or pharmacist first⁴.

What helps if that isn't enough?

If self-care hasn't helped after a sensible period, a physiotherapist or podiatrist can guide a supervised, step-by-step exercise program. This is preferred over passive treatments, and surgery is kept for ankles that haven't responded to thorough exercise-based treatment⁴.

If your ankle keeps giving way (chronic ankle instability), balance training has the broadest benefits, improving function, balance and strength¹². Ask a health professional before starting wobble or balance board exercises. It isn't clear yet whether the benefit lasts beyond the short term¹³. For Achilles tendon pain that hasn't improved in 3 months, see a podiatrist¹⁰.

Will it get better, and how can I stop it coming back?

Most new foot and ankle pain improves within 6–8 weeks¹, and soft tissue ankle injuries typically take 4–6 weeks, depending on severity¹¹. Build back to normal activities gradually as pain allows. If exercise discomfort lasts more than 2 hours afterwards, do fewer repetitions next time.

Some people keep having trouble after a first sprain: ongoing instability is linked with being less active, a lower quality of life and later ankle osteoarthritis¹⁴. To lower the chance of repeat sprains, ask about a progressive exercise program that includes balance work⁴¹². Bracing or taping reduces repeat sprains, and first sprains too, especially if you play sport⁴.