Diagnostic Guide - Ankle Pain

Injuries > Ankle Pain

Patients suffering from ankle pain are commonly seen in physiotherapy practice. Pain is usually caused by local structures within or around the ankle, however in rare cases, pain may be referred from other sources (such as the lower back).

The most common mechanism of injury in patients suffering from ankle pain is a 'rolled ankle'. This is typically due to an inversion movement whereby the foot and ankle turn inwards relative to the lower leg (figure 1). In these instances, damage to the lateral ligament of the ankle (figure 2) most commonly occurs (Sprained Ankle (Lateral Ligament)). However, other structures may also be involved such as the shock absorbing cartilage within the ankle joint, peroneal muscles or local bones (i.e. a fracture) (figure 3).

There are numerous other causes of ankle pain, some of which present suddenly due to a specific incident, others which develop gradually over time.

Below are some of the more common causes of pain in the ankle region with a brief description of each condition to aid diagnosis. Find out what may be causing your ankle pain:

Sudden Onset Ankle Pain

Common Injuries

Lateral Ligament Sprain

Tearing of the lateral ligament of the ankle (figure 2) typically following a rolled ankle (inversion Injury – figure 1) and associated with pain on firmly touching the lateral ligament of the ankle (figure 2) and often swelling. Arguably the most common cause of outer ankle pain.

Osteochondral Lesion of the Talar Dome

Damage to cartilage or bone located at the top of the talus bone (figure 3), usually due to compressive forces such as a landing from a jump and often in association with a rolled ankle.

Medial Ligament Sprain

Tearing of the medial ligament of the ankle (figure 5) typically following a rolled ankle (eversion Injury – figure 4) and associated with inner ankle pain, swelling and pain on firmly touching the medial ligament of the ankle (figure 5).

Less Common Injuries

Distal Tibiofibular Joint Injury

Tearing of connective tissue holding the tibia and fibula bones together just above the ankle associated with tenderness on firmly touching the affected region.

Lateral Malleolus Fracture

Fracture of the bony process at the outer aspect of the ankle usually due to traumatic forces (e.g. landing from a height) often in association with a rolled ankle. Associated with significant pain, swelling and tenderness on firmly touching the affected region of the bone.

Medial Malleolus Fracture

Fracture of the bony process at the inner aspect of the ankle usually due to traumatic forces (e.g. landing from a height) often in association with a rolled ankle. Associated with severe pain, swelling and tenderness on firmly touching the affected region of the bone at the inner aspect of the ankle.

Talus Fracture

Fracture of the talus bone usually due to traumatic forces (e.g. landing from a height) and associated with severe pain and swelling.

Pott's Fracture

Fracture of one or more bony processes located at the sides of the ankle associated with severe pain, swelling and tenderness on firmly touching the affected region of bone.

Dislocated Ankle

Separation of the ankle joint due to traumatic forces (e.g. motor vehicle accident / fall from a height) with severe pain, loss of function, swelling, deformity and often associated with one or more fractures

Peroneal Tendon Subluxation

Movement of the peroneal tendon out of its normal position causing a sensation of the tendon flicking in and out of position at the outer aspect of the ankle during certain movements. Associated with pain or ache located at the outer aspect of the ankle often with swelling, bruising and tenderness on firmly touching the peroneal tendon.

Peroneal Tendon Rupture

Rupture of the peroneal tendon associated with sudden onset pain in the outer aspect of the ankle usually due to a specific incident followed immediately with loss of function and significant weakness on attempted ankle eversion (figure 4). A snap or tear may be audible during injury. Swelling and tenderness on touching the tendon is typically present.

Tibialis Posterior Tendon Dislocation

Movement of the tibialis posterior tendon out of its normal position associated with pain or ache located at the inner aspect of the ankle often associated with swelling, bruising and tenderness on firmly touching the tibialis posterior tendon and a sensation of the tendon flicking in and out of position during certain movements.

Tibialis Posterior Tendon Rupture

Rupture of the tibialis posterior tendon associated with sudden onset pain in the inner aspect of the ankle usually due to a specific incident, followed immediately with marked loss of function, weakness on attempting a heel raise and later an observable drop in height of the inner arch of the foot during weight bearing. A snap or tear may be audible during injury. Swelling and tenderness on touching the tendon is typically present.

Gradual Onset Ankle Pain

Common Injuries

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Less Common Injuries

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Diagnosis of ankle pain

A thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose the cause of ankle pain. Investigations such as an X-ray, ultrasound, MRI, CT scan or bone scan are often required to confirm diagnosis and rule out other injuries (particularly fractures).

Find a Physio for ankle pain

Find a physiotherapist in your local area who can diagnose and treat patients suffering from ankle pain.

More Information

• View Ankle Stretches
• View Ankle Strengthening Exercises
• View Balance Exercises
• View detailed information on initial injury management and the R.I.C.E Regime
• View detailed information on How to use Crutches
• View detailed information on when to use Ice or Heat
• View detailed information on Do I Need Orthotics?

Physiotherapy products for ankle pain

Some of the most commonly recommended products by physiotherapist for patients with ankle pain include:

1. Crutches
2. Ice and Heat Packs
3. Ankle Braces
4. Ankle Supports
5. Heel Wedges
6. Sports Tape (for protective taping)
7. Wobble Boards (for rehabilitation)

To purchase physiotherapy products to assist with ankle rehabilitation click on one of the above links or visit the PhysioAdvisor Shop.

'PhysioAdvisor Exercises' iPhone App

 Download the 'PhysioAdvisor Exercises' iPhone App to your iPhone.

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