In short
Most ankle pain comes from a sprain, where the ligaments on the outside of the ankle are overstretched or torn. Sprains usually heal in 4 to 6 weeks with early movement, and a brace plus balance exercises lowers the chance of it happening again. Pain at the back of the ankle points to the Achilles tendon. A sudden hot, red, swollen ankle with no injury can be gout. See a doctor if you cannot put weight on it.
On this page
What causes ankle pain?
The ankle carries your full body weight on a small joint held together by ligaments and crossed by tendons, so it is easily injured. Where the pain sits is the best first clue.
| Where it hurts | Common cause |
|---|---|
| Outside of the ankle, after rolling it | Ankle sprain1 |
| Back of the ankle, above the heel | Achilles tendon problems2 |
| Behind the bony bump on the outside | Peroneal tendonitis |
| Under the heel | Usually not the ankle or the Achilles.2 See plantar fasciitis |
| Sudden, hot, red and swollen with no injury | Gout, or less often an infection3 |
Ankle sprains
A sprain happens when you roll your ankle and overstretch or tear one or more of the ligaments that hold it together. Most often the foot is pointing down and twists inwards.1 Sprains to the outside of the ankle are far more common than sprains to the inside.4
It is a very common injury. A pooled analysis of 181 studies found the highest rates in indoor and court sports, in women compared with men, and in children compared with adults.4
Symptoms
- Pain, especially when you put weight on the foot
- Swelling and bruising
- Difficulty moving the ankle or walking1
What to do in the first two days
Follow the RICE steps:1
- Rest from the activity that caused it
- Ice packs for 10 minutes every 1 to 2 hours
- Compression with a bandage to limit swelling
- Elevation, raising the ankle as often as you need
Then get it moving
Rest does not mean keeping the ankle still for weeks. You can do gentle exercises and walk on a sprained ankle, trying to walk as normally as you can.1 A review of 46 systematic reviews found strong evidence that early movement improves pain, swelling and function, and moderate evidence for exercise.5
An international guideline reached the same conclusion: a short period of immobilisation can ease pain and swelling, but people do best with tape or a brace combined with an exercise program, and supervised exercise is preferred to passive treatments.6
Anti-inflammatory medicines reduce pain and swelling after a sprain.5 The same guideline advises some care with them, because they are not free of side effects and may slow natural healing.6
How long does a sprained ankle take to heal?
Most sprains take 4 to 6 weeks. Some people still have discomfort up to 12 months later.1 Depending on how bad the sprain is, you may be advised to wear a brace for 4 to 6 weeks. Surgery is rarely needed.1
Pain that keeps coming back?
Talk it through with an Australian doctor online. No referral needed.
Could it be broken?
Sprains and fractures can look alike in the first hours. Doctors use a short checklist called the Ottawa ankle rules to decide who needs an X-ray. It is based on whether you can take four steps and whether particular points on the bone are tender.
The checklist is very good at ruling a fracture out. Across 27 studies and more than 15,000 patients, it picked up almost every fracture, and using it cuts unnecessary X-rays by 30 to 40 per cent.7
When an ankle keeps giving way
Some people go on to sprain the same ankle again and again, or feel that it is unstable. In a study that followed people after a first sprain, those who could not manage hopping and landing tasks two weeks after the injury were more likely to end up with a chronically unstable ankle.8
Two things lower the risk. There is strong evidence that wearing a brace prevents repeat sprains, and moderate evidence for balance and control training.5 A physiotherapist can set up a program of balance, strengthening and sport-specific exercises.1
Achilles tendon pain
The Achilles tendon is the thick cord at the back of the ankle that joins the calf muscle to the heel.2 Two problems are common:
- Achilles tendinopathy is a long-term overload of the tendon. It causes pain and swelling at the back of the heel or lower leg, with stiffness that is worst in the morning or after sitting still.2 It is one of the most common running injuries, affecting around 9 to 11 per cent of runners in follow-up studies.9
- A rupture is a sudden tear. It can feel like being struck on the back of the ankle, and you may hear a pop.2 This needs to be seen promptly.
Most Achilles injuries do not need surgery.2 Our guide to tendonitis explains how tendon problems are treated.
When to see a doctor
- You cannot put weight on the ankle1
- The ankle looks deformed1
- You felt a sudden blow or pop at the back of the ankle2
- Pain, swelling or stiffness are not improving, or are getting worse1
- The ankle is hot, red and swollen and you did not injure it. With a fever or feeling unwell, this is urgent3
See also foot pain and shin splints.
Next step: talk to a doctor
Answer a few quick questions and you’ll get an email about your eligibility. A consultation doesn’t guarantee any particular treatment.
References
- healthdirect. Sprained ankle.
- healthdirect. Achilles tendon injuries.
- healthdirect. Gout.
- Doherty C, Delahunt E, Caulfield B, et al. The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies. Sports Med. 2014;44(1):123-40.
- Doherty C, Bleakley C, Delahunt E, et al. Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis. Br J Sports Med. 2017;51(2):113-125.
- Vuurberg G, Hoorntje A, Wink LM, et al. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. Br J Sports Med. 2018;52(15):956.
- Bachmann LM, Kolb E, Koller MT, et al. Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review. BMJ. 2003;326(7386):417.
- Doherty C, Bleakley C, Hertel J, et al. Recovery From a First-Time Lateral Ankle Sprain and the Predictors of Chronic Ankle Instability: A Prospective Cohort Analysis. Am J Sports Med. 2016;44(4):995-1003.
- Lopes AD, Hespanhol Júnior LC, Yeung SS, et al. What are the main running-related musculoskeletal injuries? A Systematic Review. Sports Med. 2012;42(10):891-905.
This guide is general information, not medical advice. It doesn’t replace a consultation with a doctor who knows your history. In an emergency, call 000.