Ankle pain is often due to an ankle sprain. A sprain is an injury to ligaments, which connect bones to one another. In most cases of ankle sprain, the ankle is twisted inward, causing tiny tears in the ligaments. This makes the ankle somewhat unstable. The tearing leads to swelling and bruising, making it difficult to bear weight on the joint.

Once an ankle is sprained, the injury may take a few weeks to many months to fully heal. Often, the injured ankle remains a little weaker and less stable than the uninjured one. A proper recovery program can prevent this problem.

Other structures in the ankle that can be damaged and cause pain are tendons (which join muscles to bone), cartilage (which cushions joints), and blood vessels. Adjacent areas can cause pain to be referred to (felt in) the ankle -- these include the foot, lower leg, knee, and even hip.

In addition to ankle sprains and other injuries, ankle pain can be caused by arthritis, gout, pseudogout, and infection.

Gout occurs when you produce too much uric acid (a waste product in the body). The extra uric acid gets deposited and forms crystals in joints, rather than being excreted in the urine.

Pseudogout is similar to gout. In this condition, calcium deposits in one or more of your joints, causing pain, redness, and swelling.

The types of arthritis that can cause ankle pain include:

• Osteoarthritis
• Rheumatoid arthritis
• Chronic gouty arthritis
• Psoriatic arthritis
• Septic arthritis

• If you feel pain in your ankle, rest it for several days. Try NOT to move the affected area.
• If your ankle is unstable, support it, especially during standing or walking. ACE bandages work well. If this does not provide enough support, you may need to be fit for a brace. Crutches or a cane can help take the weight off a sore or unsteady ankle.
• For swelling, keep your foot elevated above the level of the heart, even while sleeping. Ice the area right away. Apply ice for 10-15 minutes every hour for the first day. Then, every 3-4 hours for 2 more days.
• Try acetaminophen or ibuprofen for pain and swelling.

Even after the pain subsides, you will need to keep pressure off of it for up to 10 days for a mild sprain and up to 5 weeks for a more severe sprain.

Once you have healed adequately, you can start exercises to strengthen your ankle and avoid injury in the future. Do not begin these exercises until a health care professional tells you it is safe to start. One exercise, for example, involves balancing on your healing foot and hopping.

For arthritis of the ankle, take medication exactly as prescribed. When the pain and swelling start to decrease, gently begin to exercise the joint again. Swimming is good, followed by stretching. Walking can be added later. Exercises can be done several times a day; but DO NOT overdo it. Pain is a message from your body to stop.

Go to the hospital or call 911 if:

• You have severe pain when NOT bearing weight.
• You suspect a broken bone.
• The joint appears deformed.
• There is an audible popping sound and immediate difficulty using the joint.

Call your doctor if:

• Swelling does not go down within 2-3 days.
• You have symptoms of infection -- the area becomes red, more painful, or warm, or you have a fever over 100°F.
• The pain does not go away after several weeks.

Your doctor will perform a physical examination, including a detailed examination of the ankles, and ask questions such as:

• Does the pain shift from joint to joint?
• Is the pain the same in both ankles?
• Did the pain begin suddenly and severely?
• Did the pain begin slowly and mildly and then get worse?
• Did the pain resolve spontaneously in less than 6 weeks?
• Does the ankle feel warm to the touch?
• Does the ankle hurt when you are not bearing weight on it?

Diagnostic tests that may be performed include the following:

• X-ray of the ankle and possibly the foot
• Aspiration of synovial fluid (fluid from the joint space) and synovial fluid analysis

• Lose weight if you are overweight. Extra pounds put strain on your ankles.
• Warm-up before exercising. Stretch the muscles and tendons that anchor the ankle.
• Avoid sports and activities for which you are not properly conditioned.
• Make sure that shoes fit you properly. Avoid high-heeled shoes.
• If you are prone to ankle pain or twisting your ankle during certain activities, use ankle support braces. These include air-casts, ACE bandages, or lace-up ankle supports.

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