Ankle Pain & Achilles Pain

Ankle injuries are separated into acute ankle injuries (sudden onset), lateral ankle pain (outside of the ankle), medial ankle pain (inside of the ankle), anterior ankle pain (front of the ankle) and achilles pain at the back of the ankle. The most common ankle injury is a sprained ankle. We explain emergency first aid in the form of cold therapy and compression for sudden onset ankle injuries as well as when to seek medical advice.

The most common cause of ankle pain is a sprained ankle. But there are a number of other less common ankle injuries as well as important conditions and ankle injuries which should not be missed! Immediate first aid (RICE) rest, ice, compression, and elevation are important for all ankle injuries, especially sprains. If the injury is severe or a fracture is suspected always seek medical advice as soon as possible.

Pain at the back of the ankle is usually related to the achilles tendon and comes on gradually over time. A sudden onset or acute achilles tendon injury may be a partial or even complete rupture of the achilles tendon which needs urgent medical assistance. Thompson's squeeze test can be done to rule out a complete achilles tendon rupture. More commonly achilles tendonitis or similar injuries tend to occur over time.

Medial or inner ankle pain refers to pain on the inside of the ankle which is not a sudden acute injury. Pain may come on gradually or from an acute injury that has not healed properly. We explain the most common causes, some less common medial ankle injuries and important conditions that should not be missed. Tibialis posterior syndrome is probably one of the more common gradual onset injuries along with stress fractures and nerve impingements. A traumatic medial ankle sprain is rare and is likely to occur with a fracture to the fibula bone at the ankle as well.

Lateral ankle pain is pain on the outside of the ankle which usually develops over time as opposed to an acute ankle injury such as a sprained ankle which happens suddenly. Chronic ankle injuries can occur after an acute ankle injury which has failed to heal properly or was not treated correctly in the beginning. The most common causes of gradual onset pain on the outside of the ankle are peroneal tendinopathy (tendinitis) and sinus tarsi syndrome.

Pain at the front of the ankle which has come on gradually rather than from a sudden twisting or trauma is usually due to impingement or tibialis anterior tendinopathy (tendinitis). Anterior ankle impingement occurs when a bony growth at the front of the ankle bone where it meets the shin bone restricts normal ankle range of motion. Tendonitis of the large tibialis anterior muscle on the outside of the shin can occur through over use.


Immediate first aid for ankle injuries

ankle supportWhat should I do for an ankle injury and when should I see a doctor? All acute and chronic ankle injuries should be treated using the P.R.I.C.E. principle (protection, rest, ice, compression & elevation). This should be applied at home for at least the first 2 - 3 days. First, protect the knee injury from further damage. Stop training or playing immediately and apply a cold therapy and compression wrap. Where applicable, use an ankle support or brace.

Rest - Refrain from exercise and try to reduce the demands of your daily activity to encourage recovery. It does not only refer to the prolonged period of time that the athlete will be out of action but also to the immediate period after the injury. An athlete must know when to stop training and allow the injured area to heal otherwise repetitive minor injuries can often result in a more severe injury that keeps the athlete out for much longer.

Ice - The topical application of ice or cold therapy to the area of the knee injury / swelling can assist in reducing the symptoms of pain and inflammation.

Compression - The use of a compression support or compression bandages to the knee can can help reduce swelling.

Elevation - Keeping the knee elevated above heart level whenever possible to help reduce swelling due to the effects of gravity.

Read more on PRICE principles >>>

When should I see a doctor?

The majority of ankle injuries, especially the minor ones can be treated at home. However, if you have any of the following symptoms including severe ankle pain, sever swelling, a pop or crack, locking and altered sensation you should seek further medical assistance.

  • Severe pain in or around the ankle joint, especially during walking.
  • Severe swelling (oedema) in the ankle.
  • An audible “pop” or “crack” in the ankle joint that is painful, particularly at the back of the ankle where the achilles tendon is.
  • A feeling when the ankle “locks” whilst trying to move it.
  • Altered sensation in the foot or ankle – such as a feeling of “pins and needles” (paresthesia) or a “loss of feeling” (anaesthesia) in the lower leg.
  • Unable to complete your normal daily activities after the initial 72 hours.

Further medical assistance can be sought through either your local Doctor or a private clinician such as a physiotherapist, sports therapist, osteopath or chiropractor.

In the first instance, if you have followed the P.R.I.C.E. principles (see above) and are still unable to walk after 72 hours or still have severe pain that is not subsiding after the first 72 hours you should visit your local A&E department for further assessment.

Secondly, if you have applied for P.R.I.C.E. principles and still have weakness or ankle pain that lasts a long time (more than 2 weeks) or have ongoing discomfort in your joint, you are highly recommended to seek advice from a specialist expert - such as a physiotherapist, sports therapist, osteopath, or chiropractor - who can provide you with advice and an appropriate and effective recovery and rehabilitation program