Ankle Pain: Causes & Treatment

ankle pain physio treatment

Ankle pain is a high priority for our physiotherapists, as we know how disruptive it can be to your work life, family life, and your ability to perform any task with comfort and ease. The first step to effectively treating ankle pain is to know what’s causing it - so our team have put together eight common causes of pain directly at the ankle that we see and treat to help give you an insight into what it may be for you.

If you’re at home with ankle pain and want to help relieve your symptoms, you can try applying ice to the area, taking non-steroidal anti-inflammatory medication, and avoiding the movements that aggravate your symptoms. Booking an appointment with your physio as soon as possible will also help reduce the likelihood of your ankle pain worsening, especially with standing and walking placing more pressure on the ankle.

Ankle Sprain

Your ankle is surrounded by ligaments that help keep the ankle joint stable and moving well with every step. When you roll onto the outside of your ankle, you forcefully stretch some of these ligaments beyond what they can safely handle, and they become sprained. This is known as an inversion sprain. Less commonly, you may roll onto the inside of the ankle, known as an eversion sprain. In both cases, the sprained ligaments cause pain and tenderness, may make it difficult for you to walk, leave your ankle feeling weak and unsteady, and result in swelling, stiffness and occasional bruising.

When assessing for ankle sprains, our physiotherapists also make sure to check the integrity of the tendons that run down the side of the leg and cross the ankle joint, as these can occasionally get damaged at the same time. This will require additional treatment, and is one of the many reasons why it’s important to have your ankle injury professionally assessed by your physio.

Chronic Ankle Instability

Due to the common nature of ankle sprains, some people choose to shrug them off and not apply proper rehabilitative care to the ankle joint. Unfortunately, this can lead to the chronic weakening of the ankle ligaments - a condition known as chronic ankle instability. As a result, your ankles can feel weaker and more unstable on a daily basis, and it is more difficult for you to go hiking or even just walk over uneven ground. Your ankle ligaments do not have the same strength to keep your ankle stable and secure and prevent another sprain.

Having chronic ankle instability can also start a vicious cycle of sustaining further sprains, which worsen the instability, which puts you at an even greater risk of sprains - and so on. If you’re worried about your ankles or have recently suffered a sprain, we recommend seeing a physio.

Ankle Impingement

Having ankle impingement means that when you point your toes up towards the sky, or down to the ground, a structure at the front or back of the ankle becomes pinched, compressed or wedged - whether that’s part of the joint capsule, a bone spur or calcification, a cyst, or something else. This impingement can produce pain, swelling, restricted movement or a blocked sensation, and even weakness around the foot and ankle. One way to tell if you may have an impingement is to test whether moving your foot up or down always produces pain or other symptoms at a specific point - if it does, then the possibility of an impingement should be investigated with your physio.

Posterior Tibial Tendon Dysfunction (PTTD)

Posterior tibial tendon dysfunction (PTTD) describes the damage to a tendon called the tibialis posterior tendon, which travels down the side of our lower leg, crosses the inside of our ankle, and attaches to the underside of the foot. The posterior tibial tendon plays a very important role in the structure of our foot and arch, as well as helping support healthy and pain-free movement every time we take a step. When the tendon is repetitively overloaded and strained, damage and inflammation occur, and the tendon can become unable to carry out its role.

Peroneal Tendonitis

Your peroneal tendons run down the outside of your leg, moving down your outer ankle and towards the outer border of your foot. When the peroneal tendons are excessively strained during their use, whether it’s a one-off event like during an ankle sprain or repetitively over time as a result of your foot biomechanics, for example, damage occurs. This is known as peroneal tendonitis, and can result in pain and inflammation at the outside of the ankle, especially when twisting the foot inwards or feeling behind or around the ‘bony bump’ at the outer ankle. Without proper care and treatment, tendon degeneration may occur over time.

Sinus Tarsi Syndrome

The sinus tarsi is a small canal on the outside of the ankle that houses ligaments, blood vessels and nerves. It can be injured by overusing or injuring the ankle, such as during an ankle sprain, resulting in symptoms like pain, burning, tingling or weakness at the ankle. Your physio will help identify if you’ve developed sinus tarsi syndrome, either on its own or alongside another injury, and ensure you get the right, timely care to help you get the best outcomes.

Tarsal Tunnel Syndrome

Tarsal tunnel syndrome produces pain, numbness, tingling or burning sensations on the bottom of the foot, often around the heel. It occurs when a prominent nerve (the posterior tibial nerve) is compressed as it passes through a dedicated space near the inside of the ankle called the tarsal tunnel, named after the small foot bones where the tunnel is located. As having tarsal tunnel syndrome means that this compression and pain can occur every time you walk or stand, it’s important to get it assessed and treated promptly with your physio.

Stress Or Avulsion Fracture

Stress fractures occur from excess pressure and stress to a bone over time, forming micro-cracks that grow bigger as the pressure isn’t managed and offloaded. This pain tends to be gradual at first, feeling more like a niggle or dull ache, and progressing to a sharper and more intense pain as the injury worsens.

In avulsion fractures, a small piece of bone is pulled off and separated due to the strain of an attaching tendon or ligament, which can occur at the bottom of the malleoli - the bones on the inside and outside of the ankle joints.

Ankle Arthritis

Finally, arthritis is also an important cause of ankle pain we see. While osteoarthritis is your typical ‘wear and tear’ arthritis that occurs over time and which most often affects the big weight-bearing joints like the ankle, rheumatoid arthritis can also affect the ankles. This occurs when the body’s own cells attack the joints and lead to painful inflammation. Gout is another type of inflammatory arthritis that can affect the ankle, occurring when uric acid crystals settle in the joint.

Get Ankle Pain Treatment With Your PhysioCentral Team

While there are a wide range of causes of ankle pain that far exceed this list, we’re proud to have a team of highly regarded, experienced and trusted physiotherapists who provide exceptional care to our clients. Every assessment starts with a comprehensive exam that helps our physio get to know everything from your medical history, to the what’s, how’s and why's of your condition, to your lifestyle and preferences so that we can create a customised plan that you can adhere to, and gain the best results from.

As part of your care, we also have a dedicated Pilates studio that helps our clients excel in their rehab, and get the best long-term outcomes.

You can book in with any of our three clinics available in Hong Kong Central and Wong Chuk Hang through either booking online, or calling us on +852 2801.4801