How can I treat my ankle pain

Ankle pain - ankle pain: causes and treatment

Pain in the ankle

Ankle pain is a very common symptom due to the enormous stress that the ankle is exposed to in everyday life and during sporting activities. The ankle forms the upper part of the ankle joint, i.e. the transition between leg and foot. It is divided into the outer ankle at the lower end of the fibula and the inner ankle at the lower end of the shin.


From a medical-anatomical point of view, pain in the ankle is limited to the area of ​​the upper ankle, but in common parlance it refers to all painful complaints in the area between the lower leg and foot. These can occur in the upper ankle joint (upper ankle joint) as well as in the lower ankle joint (USG). In addition to pain in the joint, pain in the surrounding ligaments and muscles is also perceived as ankle pain.

Symptom of ankle pain

The ankles are exposed to extreme loads in sports such as basketball, soccer, tennis or hockey. Accordingly, athletes often suffer from painful sprains, ligament strains or even fractures in the area between the foot and leg. Depending on whether the bones, muscles or ligaments are the cause of the complaints, they can be observed in a different intensity and localization.

Impairments at the transition between bones and ligaments are perceived as punctual pain, for example, while the pain in the case of ruptures of the inner or outer ligaments spreads more flat on the respective side of the foot. Because ligament tears and stretched ligaments go hand in hand with massive swelling, which presses on the surrounding tissue and thus also causes pain here.

Ankle pain is generally accompanied more frequently by swelling, redness and bruises in the area of ​​the ankle.

Regardless of whether the symptoms appear as punctual or extensive pain, they usually increase with pressure and strain. When standing, walking and running, the pain in the ankle is usually significantly increased and external pressure, such as when palpating, leads to an increased sensation of pain.

It is not uncommon for them to be accompanied by instability in the ankle. Patients bend slightly when climbing stairs, on the curb or on uneven terrain. This further increases the risk of ligament stretching, tearing and ankle fractures. Theoretically, the foot can bend inwards or outwards, but in most cases those affected bend their feet inwards. Accordingly, they tend to damage the outer ligaments. The twisting of an ankle can also affect the bones of the ankle, which also leads to ankle pain.

The ankle joint is stabilized by numerous ligaments and so-called syndesmoses (ligamentous connections made of connective tissue). In the area of ​​the ankle, the ligamentum tibiofibular interosseum, ligamentum tibiofibular anterius (anterior syndesmotic ligament), the ligamentum tibiofibular posterius (posterior syndesmotic ligament) and the ligamentum tibiofibular transversum should be mentioned. They give the upper ankle stability, but are exposed to correspondingly high loads.

Other ligaments that hold the ankle together are the ligamentum deltoideum (so-called delta ligament) and the ligamentum collaterale laterale (outer ligament). The strongest ligament in the human body, the Achilles tendon, sits in the back area between the foot and the lower leg. All of the ligaments mentioned can be damaged in their structure or even tear and thus cause corresponding ankle pain. However, the most common are strains, strains and ruptures of the outer ligaments.

Causes of ankle pain

A possible cause of pain in the ankle area is damage to the surrounding ligaments. These, in turn, can be the result of chronic overloading, trauma injuries caused by ankle twisting or a congenital weak ligament.

In view of the high stress to which the ankle joint is exposed, especially during sporting activities, signs of wear and tear in the joint can often be observed in athletes, which under certain circumstances can also lead to ankle arthrosis. In this case, the cartilage layer in the joint disappears, the load-bearing capacity is significantly reduced and those affected complain of pulling pains inside the ankle joint. In the long term, the ankle joint completely loses its functionality and becomes stiff.

Violent twisting of the foot can cause a fracture of the ankle, which in turn causes massive ankle pain. Such an ankle fracture is usually associated with stretching or rupture of the ligaments. Another possible trigger is the so-called os trigonum syndrome. The os trigonum is a small bone at the back of the talus. If the surrounding ligament structures (ligamentum fibulotalare posterius and ligamentum deltoideum) are heavily used, irritation at the level of the os trigonum can occur, which leads to persistent pain behind the outer malleolus.

Since ligament tears or elongations as well as broken ankles are usually associated with massive swellings and bruises, there is a risk of tissue scarring during healing, which can lead to painful blockages in the ankle area. The mobility of the ankle is significantly restricted and extremely painful pulling is evident in certain positions.


In addition to palpating the ankle, imaging methods such as x-rays and magnetic resonance imaging are well suited for making a diagnosis. They can be used to show the structure of ligaments, muscles, cartilage and bones and to clearly identify broken ankles, torn ligaments or osteoarthritis diseases. The os trigonum syndrome can also be determined with the help of imaging techniques. Ultimately, diagnosing ankle pain is usually not a problem. Treating the causes, on the other hand, is often much more difficult.

Treatment for ankle pain

Basically, the therapy for a sore ankle is based on the respective causes of the complaints. For example, if there is a torn ligament there is still no way around a splint, in the case of a broken ankle a plaster of paris is usually required and sprains are fixed with a bandage. In addition to the immobilization, cooling and elevation should help against the swelling.

If torn ligaments do not grow back together despite the splint, an operation may be necessary in which the existing ligaments are either reconnected or replaced. Surgical intervention may also be advisable for ankle osteoarthritis and os trigonum syndrome.

With the minimally invasive method of so-called ankle joint arthroscopy (reflection of the ankle joint), loose bone fragments that threaten to block the joint can be discovered and removed after an ankle fracture. This method can also prevent the osteoarthritis-related shrinkage of the cartilage layer.

In any case, physiotherapy is an integral part of the treatment of ankle pain. Physiotherapy should avoid incorrect loads, stabilize the joints and relieve pain in the long term. In the context of physiotherapy, attempts are also made to eliminate existing restrictions on movement.

Holistic treatment approaches

Massages can also help relieve the discomfort. In addition, so-called Rolfing and osteopathy offer possible treatment approaches for therapy. In accordance with their holistic approach, further complaints of the patient, such as knee pain, kneecap pain, walking difficulties, back pain, lower back pain or even neck tension are taken into account in the treatment of ankle pain with these methods. Although the connection between the symptoms may not be apparent to outsiders at first glance, the success often proves that these holistic treatment approaches are right.

Preventing pain in the ankle

In order to minimize the risk of ankle pain, it is important to wear suitable footwear, especially when exercising. In addition, stretching exercises can help against existing problems and at the same time have a preventive effect against ankle problems.

Physiotherapy also plays a prominent role in prevention. If, for example, ligaments are torn or stretched, the ligaments are not adequately stabilized by appropriate training, there is a risk of permanent instability and the risk of renewed injuries. By taping the ankle during sports or a stabilizing support stocking, the susceptibility to twisting can be eliminated, but these aids cannot replace the fully resilient and functional structure of the ligaments. (fp)

Author and source information

This text complies with the requirements of specialist medical literature, medical guidelines and current studies and has been checked by medical professionals.

  • Hospital of the University of Munich: Arthrosis of the ankle, (accessed on 02.09.2019), LMU
  • Michael Hammer: Rheumatoid arthritis (chronic polyarthritis), Deutsche Rheuma-Liga Bundesverband e.V., (accessed on 02.09.2019), Rheumaliga
  • Nikolaus Wülker et al .: Pocket textbook on orthopedics and trauma surgery, Thieme Verlag, 3rd edition, 2015

Important NOTE:
This article is for general guidance only and is not intended to be used for self-diagnosis or self-treatment. He can not substitute a visit at the doctor.