What are Common Causes of Ankle Joint Pain?

Ankle joint pain may be caused by a number of conditions at the talocrural joint. It may be the result of an acute injury like a ligament sprain or tear, muscle strain or tendon rupture, or bone fracture; a repetitive stress injury that develops over time like Achilles tendinitis; or an inflammatory disease like osteoarthritis. Though there are many conditions that feature joint pain as a symptom, these are among the more common causes of ankle joint pain.

Ligament injury is a common cause of ankle joint pain. Sprains are particularly common, in which the ligament is abruptly overstretched. Severe sprains can result in partial or complete ligament tears. Most often affecting the anterior and posterior talofibular ligaments on the outside of the joint, as when the foot is rolled outward at the ankle, sprains cause pain as well as tenderness, swelling, bruising, and difficulty in moving the joint.

Damage to structures such as a muscle tendon, can also result in pain felt at the ankle. One common injury site is the Achilles tendon, which crosses the back of the ankle joint and connects the gastrocnemius and soleus muscles of the calf to the heel bone. This tendon, which pulls upward on the heel when these muscles contract and plantarflexes the ankle joint, can be abruptly strained or torn by a forceful movement like jumping, sprinting forward, or changing direction suddenly. It can also be damaged over time by repetitive motions like running or jumping, resulting in Achilles tendinitis, a common source of ankle joint pain in runners and other athletes. Both types of injuries will result in inflammatory pain on the back of the ankle and tenderness, and in severe cases, bruising and an inability to put weight on the foot.

Ankle joint pain is also commonly a result of a stress fracture in the tibia or fibula, a hairline split in the bone that is incurred by repetitive impact movements like jumping and running. More common in the tibia, this type of injury is often seen just above the ankle on the medial malleolus, the rounded bony protrusion felt on the inner ankle. It is characterized by pain high on the inside of the ankle that may run up the shin and that increases upon placing weight on the foot.

An additional source of ankle joint pain is not injury but disease, commonly osteoarthritis. Osteoarthritis tends to occur with age, although injury and obesity may hasten its symptoms, and involves degeneration of joint structures like the disks that cushion and absorb weight at the joint. This condition causes painful stiffness at the joint, particularly following periods of immobilization, which is often worse first thing in the morning. The pain may be accompanied by ankle swelling and difficulty in movement, although the pain tends to decrease once the joint loosens up.

Also known as the talocrural joint, the ankle joint is where the tibia and fibula bones of the shin meet the talus bone of the foot, which sits atop the calcaneus or heel bone. Most of the joint’s surface area is devoted to the articulation between the talus and the tibia, the larger bone of the shin that bears a large proportion of the body’s weight on the joint. A synovial hinge joint, the ankle joint can perform the movements of plantarflexion and dorsiflexion, or hinging the foot downward or upward, respectively. It is held together by several key ligaments, namely the deltoid ligament on the medial or inside surface of the joint between the tibia and talus, the anterior and posterior talofibular ligaments on the lateral or outside surface of the joint between the fibula and talus, and the calcaneofibular ligament on the posterior or rear surface of the joint between the fibula and heel bone.