Ankle Pain: Causes, Treatment, and Exercises for Relief

If you’ve ever hurt your ankle, you know that it can immediately have a ripple effect on the rest of your body. Maybe you hobble a little bit. Or your gait becomes slightly stilted. When your ankle hurts, your whole body often has to adjust. The issue with these seemingly minor shifts: They can cause strain in your other leg, plus your knees, hips, and back.

“Ankles are essential for mobility and balance, so when you have ankle pain, it’s vital that you take care of it,” says Lori Walter, PT, DPT, a physical therapist at Hinge Health.

In most cases, ankle pain can be managed with at-home treatments, including exercise and physical therapy, so don't simply adjust to the pain assuming it’ll pass. Take it from Hinge Health members who found relief after physical therapy. 

"Before, whenever I did yoga and had to balance on my injured ankle, I couldn't do it,” says one member. “If I tried to push through, my ankle would bother me afterward. Now, I don't have that. I can do balancing poses, and I can walk with confidence.” 

Another member had this to say after working with a physical therapist: “While in Chicago, I took a three-mile walk with minimal discomfort. I really felt the stability and strength in my ankle. I was able to enjoy something that I didn’t think I could do three months ago!"

Ready to heal your ankle pain? Read on to learn more about what causes ankle pain and how to prevent and manage it — especially with exercises from Hinge Health physical therapists.

What Is Ankle Pain?

Ankle pain is a general term for pain in or around the ankle. “Every layer — the bones, ligaments, muscles, and tendons — adds more strength to the ankle,” says Dr. Walter. Despite their strength, ankles can be susceptible to injuries and pain.

In order to understand ankle pain, it’s important to have a grasp of all the components that play a role in the ankle’s mobility. The ankle is a hinge joint, and it has three bones (the tibia, fibula, and talus) that form the joint. The tibia and fibula in the lower leg form the inside and outside walls of the joint. The talus, a rounded bone in the foot, fits snuggly in between, similar to a wrench fitting around a nut.

The ankle is also supported by ligaments on either side that connect the bones, and by muscles in the lower leg that facilitate movement. The ankle joint moves in four ways: 

• Plantarflexion, or pointing your foot

• Dorsiflexion, or flexing your foot

• Inversion, or rotating the foot inward so the sole faces the opposite foot

• Eversion, or rotating the foot outward so the sole faces away from the opposite foot. 

The gastrocnemius and deeper soleus muscles in the calf point the foot, while the tibialis anterior muscle in the shin is responsible for flexing and inverting the foot. The peroneus longus and peroneus brevis are the primary muscles that evert the foot.

When you hurt your ankle, the pain can be sharp, shooting, or a dull ache, depending on the cause. You may feel pain or stiffness on either side of the ankle, in the back by the heel, or on the top of the foot near the shin.

Ankle Pain: A Hinge Health Perspective

A typical response after an ankle injury or when your ankle starts to hurt is to give your feet a rest. While rest is a smart move initially, you don’t want to avoid all movement as you recover. Movement helps healing.

This is especially true for ankle pain because it can affect the body’s proprioception system. “Proprioception is the awareness of your body in space,” explains Dr. Walter. “When the ankle moves, it sends signals to the brain to say where your body is in space. When you don’t move or are injured, that connection is interrupted. Without these connections, additional sprains, falls, or pain can occur since the sensory connections to the brain and subsequent reactions are impaired.”

This is why movement is so critical to your recovery. Even gentle movements like circling the ankle, pumping it like on a gas pedal, or walking can stimulate and retrain the proprioception system, while improving strength and flexibility to prevent more ankle pain in the future.

Causes of Ankle Pain

Sometimes the cause of ankle pain is obvious, like a sprain caused by a trip or fall. Other times, you may have no idea why your ankle hurts. It could be an injury like tendinitis brought on by certain exercise habits, like doing too much too soon or not warming up properly.

That can cause stress and strain on the ankle because it’s not being engaged properly. “Often, with the right strength and flexibility, these types of problems are not an issue because you're using your foot and ankle in the most optimal way,” says Dr. Walter.

Here are some of the most common reasons you may experience ankle pain:

• Sprains are one of the most common ankle injuries with about 2 million cases occurring annually in the U.S. Ankle sprains occur when your ankle rolls inward or outward too far and stretches the surrounding ligaments beyond what’s normal. Sprains often occur while playing sports, but they can also happen when stepping off a curb or walking on uneven surfaces. While most ankle sprains can be treated conservatively at home, it’s important to rehab your ankle to prevent reinjury.

• Tendinitis (tendonitis). Tendons attach muscles to bones and can become inflamed. Quick-moving activities with lots of starts and stops and direction changes, like skiing or pickleball, can sometimes result in injuries that stretch or tear a tendon. The Achilles tendon, for example, attaches the calf muscle to the heel and can result in ankle pain when irritated.

• Arthritis. Osteoarthritis is the most common type of arthritis. It’s characterized by changes in the shock-absorbing cartilage around a joint that can result in the bones rubbing against each other. While these changes are a normal part of aging and don’t necessarily cause symptoms, they can contribute to ankle pain and stiffness for some people.

When to See a Doctor for Ankle Pain

Most ankle pain can be managed with self-care, but see a doctor if you notice any of the following:

• Can’t bear weight on your ankle 

• Experience severe pain after an accident or injury

• Have an open wound

• Pain accompanied by fever, redness, and swelling

Prevention Tips for Ankle Pain

If you’re prone to ankle pain, there are many things you can do to manage and prevent it. 

• Warm up first. Before any activity, even a brisk walk in the park, you should spend at least a few minutes warming up. You can stroll, circle your ankles, or do dynamic moves, like the ones recommended below. These gentle movements increase blood flow to the ankle area and expand the joint’s range of motion to help prevent injury.

• Progress gradually. When trying new workouts or activities, build up the duration and intensity slowly.

• Wear proper footwear. While there’s no such thing as the perfect shoe, sport-specific shoes aren’t just marketing hype. Running shoes provide extra cushioning to absorb impact. Court shoes are designed for quick starts and stops and lateral movements that can be hard on ankles. Hiking shoes provide stability on uneven surfaces, and high-top styles offer extra ankle support. 

• Watch out for obstacles. Curbs, uneven sidewalks, rocky terrain, and fallen branches can be hazardous to your ankles when running or walking. To spot these obstacles and have time to react, keep your eyes on the road about six to 10 feet ahead of you.

• Cross train. Switching up your activity challenges your muscles in different ways to avoid stressing one area of the body. If you’re prone to ankle injuries or have chronic ankle pain, alternating higher-impact activities, like running, jumping, and jogging, with lower-impact exercise, like walking, swimming, and biking, will give your ankles some beneficial recovery time while you still get a good cardio workout.

• Maintain a healthy weight for you. Everyone’s ideal weight is different, but maintaining a body weight that works for you can help reduce extra pressure on your ankles.

• Move often. As Hinge Health physical therapists say, movement is medicine. It’s important to move your joints through a wide range of motion. This stabilizes and strengthens the muscles in and around your ankles, which helps prevent pain, stiffness, and injury.

• Do exercise therapy. Targeted movements, exercises, and stretches increase the strength and flexibility of the structures in and around your ankle. (More on that below.)

Treatments for Ankle Pain

The right course of treatment for ankle pain depends a lot on the nature and cause of your pain. The following tips can provide relief for most cases of mild to moderate ankle pain.

• Give your ankles some P.E.A.C.E. and L.O.V.E. The R.I.C.E. method (rest, ice, compression, and elevation) has been a longstanding model for self-care, but P.E.A.C.E. and L.O.V.E. offers a new, more comprehensive approach to treating problems like ankle pain.

• Tape it. “Taping the ankle with elastic athletic tape (like k-tape) helps stabilize the ankle,” says Dr. Walter. “It also gives additional proprioceptive feedback to support the positional awareness of your ankle to improve your balance and limit the potential for reinjury.”

• Put your feet up. Elevating your ankle above your heart can reduce inflammation and can be a nice complement to exercise therapy.

• Try ice and heat. Icing reduces swelling and inflammation and can help with acute and chronic ankle pain. Heat increases blood flow and can reduce stiffness. You can apply heat or ice as needed for 20 minutes at a time, but avoid using heat to treat a new injury as this can delay healing. 

While all of the above steps can help ankle pain, one of the most effective treatments is exercise therapy.

These seven moves build strength and increase flexibility for ankle pain relief. Strong, flexible muscles around the ankle create a support system to ease pain and protect against injury. When you strengthen these muscles, you take pressure off the ankle joint and the ligaments that surround it. Stretching increases a joint’s range of motion, which helps distribute pressure over a larger area and reduces risk of injury. 

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

PT Tip: Don’t Stop When the Pain Stops

“Just because the pain or inflammation has subsided, that doesn’t mean that your ankle has regained full strength and flexibility,” says Dr. Walter. “Rehabilitation is the best way to return your ankle to pre-injury condition.” The biggest predictor of future injury is previous injury. That’s why it’s important to make ankle exercises a part of your regular routine even when you’re no longer in pain.

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Manganaro, D., Alsayouri, K. May 23, 2023. Anatomy, Bony Pelvis and Lower Limb: Ankle Joint. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK545158/

2. Herzog, M. M., Kerr, Z. Y., Marshall, S. W., & Wikstrom, E. A. (2019). Epidemiology of Ankle Sprains and Chronic Ankle Instability. Journal of Athletic Training, 54(6), 603–610. https://doi.org/10.4085/1062-6050-447-17

3. What Should I Do When My Foot or Ankle Pain Won't Go Away? March 21, 2023. Penn Medicine. https://www.pennmedicine.org/updates/blogs/musculoskeletal-and-rheumatology/2023/march/what-should-i-do-when-my-foot-or-ankle-pain-wont-go-away

4. When Ankle Pain May Mean Arthritis. (n.d.). Arthritis Foundation. Retrieved from https://www.arthritis.org/health-wellness/about-arthritis/where-it-hurts/when-ankle-pain-may-mean-arthritis