Ankle pain

Ankle sprain

A lateral ankle sprain is one of the most common types of ankle injuries, where the ligaments on the outside (lateral side) of the ankle are stretched or torn. It typically occurs when the foot rolls or twists inwards (inversion), causing the fibula (outer bone of the lower leg) and the ligaments on the outside of the ankle to be stressed or damaged. The ligaments that support and stabilise the ankle during lateral movement can be torn or over stretched during an ankle sprain, and it’s important to grade the injury to understand how to appropriately manage healing, recovery and rehabilitation.

Ankle sprain symptoms:

  • Pain on the outer part of the ankle.

  • Swelling (especially in Grade II or Grade III injuries).

  • Bruising.

  • Stiffness.

  • Instability.

  • Inability to Bear Weight.

Ankle impingement

Ankle impingement is a condition where there is compression or pinching of soft tissues or bones around the ankle joint, typically during specific movements like dorsiflexion (raising the foot upwards) or during activities that place pressure on the joint. This can cause pain, swelling, stiffness, and limitations in movement, and it is often associated with repetitive activities and trauma.

There are two primary types of ankle impingement:

Anterior (common for footballers):

  • Pain in the front of the ankle (anterior ankle), especially with dorsiflexion (raising the foot).

  • Swelling or stiffness in the joint.

  • Pain during activities like running, jumping, or squatting.

  • Limited range of motion in the ankle, particularly with dorsiflexion.


Posterior (common for dancers):

  • Pain at the back of the ankle, particularly during activities that involve pointing the toes or excessive plantar flexion.

  • Swelling around the Achilles tendon or posterior ankle.

  • Difficulty pushing off during walking or running.

  • Tenderness when pressing the back of the ankle.

Os trigonum

Os trigonum is a small, accessory bone that can be present in the ankle, typically located at the posterior (back) part of the talus bone. It’s a congenital condition, meaning it’s present from birth, although it may not cause problems unless it becomes irritated or injured later in life. Activities like ballet, gymnastics, football, or running that involve a lot of movements requiring the ankle to be pointed downward (plantar flexion) or pushed back (dorsiflexion) can irritate the os trigonum.

Os trigonometry symptoms:

The primary symptoms of Os Trigonum Syndrome arise from inflammation, irritation, or impingement of the os trigonum. These symptoms are very similar to posterior ankle impingement (see above) and indeed an Os trigonometry may be the cause of a posterior ankle impingement presentation.

Achilles tendinopathy

Achilles tendinopathy is characterised by pain, swelling, and dysfunction of the Achilles tendon, the large tendon that connects the calf muscles (gastrocnemius and soleus) to the heel bone (calcaneus). It is one of the most common tendinopathies in active individuals, particularly those involved in sports like running, jumping, or tennis. Achilles tendinopathy can be mid-portion (2-3 cm up the calf from the heel) or insertional (where the tendon inserts onto the bone a the heel).

Achilles tendinopathy symptoms:

  • Pain at the back of the ankle, near the Achilles tendon, that worsens with activity and improves with rest.

  • Swelling or thickening of the tendon.

  • Tenderness to the touch, especially over the tendon.

  • Stiffness and limited range of motion, particularly in the morning or after periods of inactivity.

  • Often, the pain starts during or after exercise, especially with activities that involve repetitive use of the calf muscles and Achilles tendon, like running or jumping.

Tarsal tunnel syndrome

Tarsal Tunnel Syndrome (TTS) is a condition caused by the compression or irritation of the tibial nerve or its branches as they pass through the tarsal tunnel. When the tibial nerve becomes compressed, it can result in pain, tingling, numbness, or weakness in the foot, particularly along the inner arch or sole. The condition is often compared to carpal tunnel syndrome in the wrist, but it affects the foot instead.

TTS symptoms:

  • The most common symptom is pain, usually described as a burning, shooting, or aching sensation along the inner ankle, heel, and arch of the foot.

  • Tingling or a pins-and-needles sensation (paresthesia) may be felt in the inner side of the foot, particularly the arch, heel, and toes (often the first three toes).

  • Weakness in more severe cases.

  • Pain Worse at Night.

  • Pain on Tapping (Tinel's sign).