Ankle

An ankle sprain occurs when one or more of the lateral or medial ligaments are stretched or torn—most commonly following a twisting injury or a sudden “turn” of the foot. In mild cases the ligament fibres are overstretched, whereas more severe sprains involve partial or complete rupture, compromising joint stability.

You’ll typically feel a sudden sharp pain at the time of injury, followed by rapid swelling and bruising around the ankle. Walking or bearing weight becomes painful and there may be a feeling of looseness or “giving way” when you try to stand on the affected foot.

Chronic ankle instability develops after repeated sprains weaken the supporting ligaments and cause them to lengthen, so the ankle repeatedly “gives way” during activity. Over time the joint capsule and proprioceptive feedback mechanisms also deteriorate, perpetuating instability.

The patient normally presents with a history of frequent sprains or a persistent sense of the ankle rolling outwards, especially on uneven ground. You may notice recurrent swelling, aching after prolonged standing and difficulty with balance or sudden changes in direction.

Ankle osteoarthritis is degeneration of the cartilage lining the talocrural and subtalar joints, often following previous fractures, chronic instability or high-impact loading. As the cartilage wears away, joint space narrows and osteophytes (bony spurs) form, reducing shock absorption.

You’ll experience a deep, aching pain in the ankle that worsens with weight-bearing, accompanied by stiffness—particularly first thing in the morning or after rest—and sometimes a grinding sensation (crepitus) when you move the joint together. The effected joint will often appear enlarged.

Achilles tendon injury includes both acute inflammation (tendinitis) and chronic degeneration (tendinopathy) of the tendon that attaches the calf muscles to the heel. In middle-aged joggers and athletes it can progress to a sudden rupture without warning.

You’ll feel a gradual onset of pain and stiffness in the tendon area during activity, often worse first thing in the morning. Sometimes a marble sized swelling might be felt just above the tendon attachment into the heel bone. In the event of a rupture there may be a loud “snap”, immediate sharp pain and difficulty pushing off or standing on tiptoe, with a palpable gap in the tendon.

An ankle fracture is a crack or complete break in one or more of the bones forming the ankle joint (tibia, fibula or talus), typically resulting from a fall, direct impact or severe twist. Fractures can vary from hairline cracks to displaced breaks requiring realignment.

You’ll notice intense pain at the moment of injury, swelling and often visible deformity. Weight-bearing is usually impossible, and pressing over the bone surfaces reproduces sharp tenderness.

Tarsal tunnel syndrome is entrapment of the posterior tibial nerve as it passes beneath the flexor retinaculum on the inner ankle, caused by swelling, varicose veins or structural issues. It leads to neuralgia and associated weakness in the foot.

You’ll experience tingling, burning or electric-like shocks on the sole of the foot and inner ankle, often worse at night or with prolonged standing. There may also be numbness in the toes and a positive Tinel’s sign when tapping over the tarsal tunnel.

Flat or over-pronated feet occur when the medial arch collapses gradually over time, causing the ankle to roll inwards and altering the load transfer through the lower limb. This structural alignment issue can arise congenitally or as a result of ligament laxity and muscle imbalance.

It presents with visible flattening of the arch when weight-bearing, inward tilting of the heel, and diffuse aches in the ankle, shin or knee after activity. Shoes often wear unevenly on the inner edge, and standing for long periods may provoke fatigue in the foot and calf and plantar fasciitis (see Foot section).

Gout is an inflammatory arthritis caused by deposition of urate crystals in joints, most commonly affecting the ankle and foot. It presents in acute flares triggered by dietary factors, alcohol or dehydration.

It presents with a sudden onset of severe pain, redness and swelling in the ankle, often waking you at night. The joint feels hot to touch, and even light contact—such as a bed sheet—can be unbearable during an attack.

Rheumatoid arthritis is an autoimmune condition that causes symmetrical inflammation of synovial joints, including the ankles. Chronic synovitis leads to joint swelling, pain and progressive erosion of cartilage and bone.

Early signs include persistent swelling, warmth and stiffness in both ankles—especially in the morning lasting more than 30 minutes. You may also experience systemic symptoms such as fatigue and mild fever.

An osteochondral lesion of the talus is damage to the cartilage and underlying bone on the inner surface of the ankle joint, often resulting from an ankle sprain or fracture. The injured cartilage may fragment, causing loose bodies within the joint.

You’ll feel deep, aching ankle pain that worsens with weight-bearing, along with intermittent swelling and a catching or locking sensation as loose fragments interfere with movement. Tenderness over the anterolateral or posteromedial joint line may be present.