Ankle pain (inside and outside) can have a variety of causes, including: fracture of the outer or inner ankle, sprain, swelling, Achilles tendonitis, bursitis of the heel, injuries; they can also occur as a result of arthritis or overload.
The ankle is a complex network of bones, ligaments, tendons and muscles. It is strong enough to support body weight, but prone to injury and pain.
The ankle joint located there consists of the distant (distal) end of the shin and the fibula, which articulate with a large bone of the foot, the ankle bone.
The lower part of the shin represents the inner ankle, while the lower part of the fibula forms the outer ankle.
Pain can occur on the inside or outside of the ankle, but also on the back of the foot or along the Achilles tendon that connects the calf to the heel.
As a rule, ankle pain can be treated well with home remedies, but it can take quite a while for it to subside.
Severe pain in the ankle must be examined by the doctor, especially if it occurs as a result of injury.
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Causes of ankle pain
Usually, ankle pain is not caused by other medical conditions.
If the reason for the ankle pain is known, an appropriate method of treatment can be used.
Without a correct diagnosis and therapy, the original injury may not heal optimally and the ankle may be more susceptible to injury in the future.
External ankle pain
A joint capsule infection (synovitis), a recently sprained ankle, a tear of the calf muscle tendon or undetected bone fractures, these are all possible causes of pain on the outside of the ankle.
Sprained ankle
A sprained ankle is possibly the most common sports injury that causes ankle pain.
After a first sprain, relapses are likely.
A sprained ankle is an incomplete dislocation of the ankle bone (the uppermost bone of the foot) with respect to the tibia and fibula and is caused by an abrupt twisting motion.
Symptoms vary depending on the severity of the injury; with mild trauma, the pain may occur only at the outer ankle and the joint may only be restricted in certain movements.
With severe distortion, the ankle swells sharply, bruising occurs, an appearance with the foot is not possible, pain and functional impairment exist with all movements of the ankle joint.
Walking on tiptoe or on the outer edges of the foot becomes extremely difficult.
In the acute phase, the treatment is carried out by cooling and, above all, raising the foot against the swelling.
After the first few days, joint manipulation is the best treatment measure to bring the bones back into their correct axis position and to release joint blockages.
An important role in the prevention of relapses is played by the proprioceptive training program, which provides exercises for balance.
Fracture of the outer ankle The fracture of the outer ankle (the bone protrusion on the outside of the ankle
) is usually caused by traumatic forces (e.g. a fall from a height) or by a violent sprain of the ankle joint.
Typical symptoms: severe pain on the outside of the ankle (especially when occurring), swelling and numbness when palpating the injured area.
The ability to move is restricted until the bone callus has formed. Physiotherapy and rehabilitation are important to successfully complete the healing process.
Pain in the ankle nerves
If the patient has not suffered any injuries, the external ankle pain may be caused by the syndrome of the deep fibula nerve or a herniated disc in the lumbar region.
Depending on the severity of the nerve inflammation, a stabbing pain may develop, which may significantly limit everyday activities.
There may also be tingling in the toes or on the outside of the foot.
Synovitis on the ankle can cause pain in the front side of the ankle, just in front of the outer ankle.
As a rule, the pain increases significantly during activities such as climbing stairs, walking and running, and subsides during periods of rest.
The ankle is swollen and the movement of the ankle is restricted.
The rupture of the long fibula muscle tendon can result in the instability of the joint.
An injury to the short fibula muscle tendon is more common in comparison.
Usually, the crack is located at the level of the tip of the fibula. In the course of the tendon, swelling is usually noticeable and then permanent pain occurs on the outside of the ankle.
The lateral pain sits just behind the outer ankle.
The pain increases with activity, especially when walking on uneven terrain and when loading the outer edge of the foot.
Skiing is a common cause of dislocation of the fibula muscle tendon. It can also occur in connection with an ankle sprain.
The dislocation (exit of the tendon from its plain bearing) is caused by the strong contraction of the calf muscles when the skier presses the skis into the snow to perform a turn.
The person concerned may hear a kind of snapping during the accident. Pain and swelling of the ankle in the posterior, outer area, behind the outer ankle.
Symptoms intensify when walking on uneven ground above the outer edges of the foot.
The peroneal tendon may remain luxated or be returned to its correct position (reposition), but it is easily possible that it will be shifted again during activity.
Peroneal tendon endinitis is the inflammation and degeneration of the tendons on the outside of the ankle.
It often occurs as a result of a sprained ankle or is caused by the supination position of the foot.
The symptoms are pain with pressure and stretching of the tendon, as well as discomfort when trying to walk on the outer edges of the foot.
Ankle swelling and movement restrictions are rare.
Optimal treatment includes correction of foot position and manual physiotherapy.
A lesion on the outer ligament of the ankle joint (anterior roller bone-fibula ligament) occurs as a concomitant injury of an ankle distortion.
The pain is noticeable on the outside of the ankle when pressure is applied to the ligament and the foot is turned inwards.
Signs and symptoms include swelling and bruising.
The ankle is unstable, especially if the other outer ligaments of the ankle joint are also torn.
Snowboarder’s Ankle refers to a special bone fracture; affected is the lateral tali process, a process of the ankle bone.
The patient complains of punctual pain, swelling and bruising in front of the outer ankle.
The area around the outer ankle feels numb. This bone fracture clinically resembles a sprained ankle.
It is often not shown on X-rays, patients with ankle sprain often get the diagnosis of the bone fracture with delay.
The symptoms cannot be remedied by physiotherapy in the acute phase and the patient develops chronic pain on the outside of the ankle.
Internal ankle pain
The most common causes are fractures of the inner ankle, tendinitis of the posterior tibia muscle and internal ankle sprains.
Inner ankle fracture
In a fracture of the inner ankle, the bone protrusion on the inside of the ankle breaks. It is usually caused by traumatic injuries, such as a fall from a greater height or when the foot is placed incorrectly and twists.
In the ankle there is very severe pain (especially when walking, when the broken side is loaded), pressure discomfort and swelling of the ankle and foot.
Tendinitis of the posterior tibial muscle causes severe pain on the inside of the ankle joint.
The cause is trauma or a foot deformity: flatfoot or valgus position of the ankle.
Symptoms occur with pressure on the tendon, stretching or tension of the posterior tibial muscle.
If tendonitis is not treated, walking can become problematic, especially if the inside of the foot is stressed.
Pain in the ankle nerves
If the ankle causes pain from morning to evening and also in bed, it could be inflammation of the leg nerves.
The most common neuralgia of the ankle is tarsal tunnel syndrome on the inside of the foot and deep fibula nerve syndrome (a branch of the sciatic nerve) when symptoms appear on the outside of the foot.
In this case, the ankle is not swollen and movement is not restricted, but the pain is constant even at rest and at night.
As a rule, patients with sciatica feel the pain in the back or outside of the ankle and calf.
Treatment can be done manually with exercises and manipulations that free the pinched nerves.
If conservative therapy turns out to be inadequate, surgical intervention may be considered to free the nerve.
