Ankle Pain: Causes, Treatments and When to go see your Doctor or get an X-Ray

Ankle pain can stem from a wide variety of causes, each affecting different structures in the area. Trauma is one of the most straightforward—sprains, fractures, or dislocations are common outcomes of accidents, falls, or high-impact sports. These injuries often involve ligaments or bones, causing swelling, bruising, and difficulty bearing weight.

Chronic conditions are another major category. Osteoarthritis can wear down the cartilage in the joint over time, leading to stiffness and discomfort. On the other hand, inflammatory conditions like rheumatoid arthritis or gout can trigger sudden, sharp pain due to swelling and irritation inside the joint.

Tendons and muscles are frequent sources of trouble. Overuse injuries such as Achilles tendinopathy develop gradually, particularly in active individuals, while tears or ruptures can happen suddenly. Flat feet or high arches can also create stress in the ankle, affecting its mechanics and causing strain over time.

Even infections and skin problems, like cellulitis, shouldn’t be overlooked. These might not start in the joint but can spread or mimic joint pain, adding to the confusion. Occasionally, the pain isn’t local to the ankle at all—nerve issues, like sciatica, can radiate down the leg and make it feel as though the ankle is the problem.

With such a wide range of possibilities, pinpointing the exact cause often requires a closer look at how and when the pain started, along with any accompanying symptoms.

If you have had a traumatic injury and have severe pain, you may require an X-ray. Symptoms suggesting a fracture are if you are unable to stand on the injured foot, the foot appears to be at a different angle to normal, and if there's significant bruising and swelling around the area.

Tight or badly fitting footwear and simple strains and sprains can be common causes of ankle pain, and these usually require only treatment at home.

Healthwords pharmacists' top tips

Resting the foot, raising it up, and taking some simple pain relief such as paracetamol is a good place to start. If there has been an injury, an ice pack or bag of peas wrapped in a tea towel may provide some relief.

Your pharmacist is an expert and can recommend further treatments such as different painkillers, topical treatments or support for the injured ankle.

Most causes of ankle pain will improve with some self-treatment. If you still have pain that is not improving after two weeks then book a routine appointment with your doctor to discuss this.

You should seek more urgent medical attention if you have severe pain. If you are concerned you have suffered a fracture, or have had a high impact injury to your ankle, you will likely require an X-ray.

If you have severe symptoms such as numbness, weakness, fevers, or a break to the skin and have diabetes you should seek urgent medical advice from your doctor or 111.

The doctor will ask about your symptoms, your medical history, any relevant family medical history and what medications you take. They will examine your ankles, and potentially do other tests such as a blood test and possibly an X-ray.

If you attend a hospital, a doctor or nurse will examine you, and if there is a concern your ankle has is broken you will have an X-ray and various other tests. If a fracture is confirmed you will be advised of the best next step.

Could it Be Referred Pain?

Not all ankle pain originates in the ankle itself. Sometimes, issues higher up the leg or spine can create sensations that feel like ankle pain. For instance, sciatica—a condition where a nerve in the lower back is irritated—can send shooting pain down the leg and into the ankle. Similarly, knee problems or hip joint issues might alter how you walk, putting strain on the ankle and causing secondary discomfort. If your ankle pain seems out of proportion to any visible injury or comes with unusual symptoms, such as tingling or weakness, this could be worth exploring with your doctor.

Are Your Shoes to Blame?

Footwear plays a bigger role in ankle health than most people realise. Shoes that are too tight, offer poor arch support, or have high heels can throw off your balance, strain your tendons, and lead to chronic pain. Athletes are particularly vulnerable to these issues when wearing worn-out trainers or those that don’t suit their foot type. Swapping out poorly fitting footwear for more supportive options can often make a world of difference.

Prevention Tips for Everyday Life

Keeping your ankles strong and flexible is key to avoiding pain. Simple exercises, like calf raises and ankle circles, can build strength and improve stability. If you're prone to injuries, consider using supportive braces during high-risk activities, such as running or playing sports. Maintaining a healthy weight also reduces stress on your joints, particularly if you’re active.

When It's More Than Pain

If ankle swelling doesn’t improve with rest and ice, or if it’s accompanied by redness, warmth, or fever, it might be a sign of infection or a condition like deep vein thrombosis (DVT). In these cases, immediate medical attention is essential. Conditions like these require targeted treatments that go beyond essential pain relief.

Stay Ahead of Chronic Issues

Chronic ankle pain can sometimes creep up due to repetitive strain or untreated injuries. Even if the pain subsides temporarily, ignoring it can lead to long-term problems like joint instability or arthritis. Catching these issues early, through a proper assessment and treatment plan, can save you a lot of trouble down the road.