Ankle Injuries — When to See a Doctor

Ankle injuries are very common, especially if you’re active or play sports. If you experience an injury or have sudden ankle pain, do you need medical attention? Or should you rest and see if it gets better?

If you have certain symptoms, do not try to tough it out or play through the pain, says Gregory Waryasz, MD, CSCS, a Mass General Brigham sports medicine specialist and certified strength and conditioning specialist. Dr. Waryasz is director of Foot and Ankle Sports Medicine at Massachusetts General Hospital, orthopaedic consultant for Northeastern University, and team physician for Boston Public Schools and the Boston Renegades Beep Baseball Team.

Sudden pain, swelling, trouble walking, and other symptoms can signal a need for medical attention. Waiting too long can lead to repeat injuries, more complex treatments, worse long-term results, and even arthritis.

“Acute, sudden pain in the ankle with a trauma is often caused by an ankle injury,” Dr. Waryasz says. “If you feel a pop, or if you feel like someone kicked you in the back of the leg but nobody’s there, then you should be seen within 24 to 48 hours.”

Anatomy of the ankle

The ankle is a joint where three bones meet:

1. Tibia, or shinbone, forms the inside of your ankle

2. Fibula, a smaller bone in your lower leg, forms the outside of your ankle

3. Talus, a small cone-shaped bone, sits between your heel and your tibia or fibula

The ankle also contains:

• Cartilage: Cartilage is a substance that helps bones glide against each other. It also helps absorb impact when you walk, run, or jump.

• Ligaments: Ligaments are strong bands of tissue that hold your bones together and help stabilize joints. Your ankle contains three main sets of ligaments—medial ligaments, lateral ligaments, and syndesmotic ligaments.

• Tendons: Tendons are cord-like bands that connect muscles to bones. Your ankle contains the posterior tibial tendon, two peroneal tendons, and the Achilles tendon. The Achilles tendon is the largest tendon in your body. It is prone to injury in active individuals.

Types of ankle injuries

Acute ankle pain can occur when any of those structures are injured. The most common ankle injuries among active, athletic people are:

• Fracture, a broken bone

• Sprained ankle, an injury to one or more ligaments that can range from mild to severe

• Strain, an injury to a ligament or muscle that is less severe than a sprain

• Tendon injury, when a tendon tears or ruptures

Should I go to the doctor for an ankle injury?

Dr. Waryasz suggests medical attention for any of the following symptoms, especially if they last more than 24–48 hours:

• Bruising or swelling in the area

• Deformity, meaning your ankle looks misshapen

• Popping or cracking noise, specifically when it’s associated with pain

• Sudden, sharp pain

• Tenderness when you touch the injured spot

• Trouble moving your ankle, walking, weightbearing, or lifting your foot

An ankle sprain and a broken ankle can feel similar, and both can be serious. “Many people may think, ‘It’s just an ankle sprain,’” Dr. Waryasz says. “But sprains aren’t a ‘nothing’ injury. Many sprains can lead to chronic instability and problems down the road. A fair number of sprains lead to chronic instability of the ankle that can require surgery.”

What can cause ankle pain without injury?

Ankle pain is not always caused by sudden trauma or injury. It also can be chronic, or long-lasting. Conditions that cause chronic ankle pain include:

• Arthritis: Various forms of arthritis may affect your ankle. Arthritis tends to cause ongoing soreness or achiness.

• Blood clot in your leg: A blood clot anywhere in your leg can cause ankle pain. It usually occurs along with swelling and pain in other areas of the leg, such as behind your knee.

• Chronic tendinopathy/tendonitis/tendinosis: These are overuse injuries of the tendons and can be rather painful.

• Gout: Gout may be felt in several areas of your foot. It can make your skin in the area look red or feel hot to the touch. Gout often occurs just after a person significantly changes their diet.

• Infection: Bacterial and fungal infections can lead to ankle pain and can be very serious. Lyme disease is one example of a common infection in New England.

• Nerve injury: Damage to a nerve anywhere in your leg can cause pain in your ankle and elsewhere. This often feels more like numbness or tingling.

• Plantar fasciitis: Although this is technically a foot condition, pain and tenderness can extend to your ankle.

• Rheumatologic conditions: Chronic autoimmune conditions such as rheumatoid arthritis and lupus can lead to joint and tendon inflammation.

• Stress fractures: Stress on a bone can lead to small cracks that cause dull or sharp pain. The pain is typically focused on the bone involved.

If you have chronic ankle pain, Dr. Waryasz suggests you rest your joint and use the RICE approach:

• Rest

• Ice (10 to 20 minutes every few hours throughout the day)

• Compression

• Elevation

You may also consider taking over-the-counter acetaminophen, ibuprofen, or naproxen. Chronic pain may go away after a few days of rest, Dr. Waryasz says. Early physical therapy can also be helpful to work on swelling control, stretching, and strengthening. But if symptoms are still occurring after several weeks of rest, that would be a reason to see a doctor, he adds.

What do doctors do for a sprained ankle and other ankle injuries?

To diagnose ankle pain, a health care provider will ask you what happened, what symptoms you have and the exact location of the pain. You’ll have a physical exam and may have imaging tests, such as an x-ray, ultrasound, or MRI.

“The anatomy of the foot and ankle is straightforward and can help us determine where the problem is,” Dr. Waryasz says. “For example, if you had some form of trauma and it hurts on the outside of your foot, then there’s a chance you broke your fifth metatarsal bone—the long bone on the outside of the foot that connects to the little toe. If it hurts over your lateral ligaments but not over the bone, it would be more likely to be a lateral ankle sprain.”

Depending on the diagnosis, your doctor may suggest a brace, walking boot, splint, cast, and/or crutches. They also might recommend physical therapy (PT), which teaches you exercises to strengthen the muscles and ligaments around your ankle. PT also can improve flexibility and balance. More severe injuries may require surgery.

Earlier treatment can provide better results 

Athletes and other active people might resist seeking treatment because they don’t want to be sidelined. But Dr. Waryasz emphasizes that treatment can be more effective if it’s started early.

“I’ve had some patients with ankle injuries who waited 3 or 4 months to get help, and so they needed more complex treatments that lead to longer times away from sports/exercise,” he says.

It’s not uncommon to change the way you walk to compensate for ankle pain. That can cause issues in other joints, such as your knee or hip. An untreated injury can make your ankle unstable, leading to repeat sprains.

“If you feel like it doesn’t take a lot for you to roll your ankle, like you’re just walking down the street and you step on a little rock and immediately your ankle gives out on you, that can be a sign that your ankle is weaker. And if you have repetitive ankle sprains, it can lead to arthritis over time if not treated,” Dr. Waryasz says.

Early intervention often involves PT, which can be very effective and allow you to keep doing the things you love.

“Early physical therapy is very helpful for a lot of these conditions. The goal is often to keep you active through injury—you’re getting treatment so that you can continue to be active.”