Ankle pain: causes, treatment and when to see a doctor

Ankle pain has many causes, and the pattern of symptoms gives the best clue. The NHS pages used here describe injuries, such as sprains and broken bones, and joint conditions, such as gout and osteoarthritis.

NICE Clinical Knowledge Summaries (CKS) says a sprain is a stretch or tear of a ligament, typically affecting the ankles, knees, wrists and thumbs, and that the risk is increased in people who frequently participate in sports.

The NHS says it is likely to be a sprain or strain if you have pain, tenderness or weakness around the ankle, the area is swollen or bruised, you cannot put weight on it or use it normally, or you have muscle spasms. CKS lists a sense of the joint “giving way” as a possible feature after severe injuries.

For the first 2 to 3 days after a sprain or strain, the NHS advises PRICE therapy. This stands for protection (a support or supportive shoes), rest (stopping exercise and avoiding weight on the injury), ice (an ice pack wrapped in a tea towel for up to 20 minutes every 2 to 3 hours), compression (a bandage to support it during the day) and elevation (keeping it raised on a pillow).

The NHS says to try to avoid heat, alcohol and massage for the first couple of days to help prevent swelling, and that when you can move the injured area without pain stopping you, you should try to keep moving it so the joint does not become stiff.

A pharmacist can help. The NHS suggests trying painkillers like paracetamol at first and ibuprofen gel, mousse or spray to bring down swelling, and ibuprofen tablets if needed.

The NHS says that after 2 weeks most sprains and strains will feel better. It advises avoiding strenuous exercise such as running for up to 8 weeks because there is a risk of further damage, and says severe sprains can take months to get back to normal.

CKS lists complications of more severe injuries as chronic instability, loss of function, chronic pain and swelling, a risk of re-injury and post-traumatic osteoarthritis. It says referral to physiotherapy should be considered if symptoms are not improving as expected.

The NHS says to get medical advice as soon as possible if you think you have broken your ankle, because it may need treatment to heal properly, and not to worry if you are not sure. You will usually have an X-ray to check.

While waiting to see a doctor, the NHS suggests raising the ankle if possible, holding an ice pack wrapped in a towel on it for 15 to 20 minutes every 2 to 3 hours, not putting weight on it if possible, and not eating or drinking anything in case you need surgery.

Treatment may include a special boot, a plaster cast, a doctor moving the bones back into place, or surgery, according to the NHS. A very minor break may not need any treatment.

The NHS says gout causes sudden, severe pain in a joint, usually the big toe but sometimes the ankles or other joints, with hot, swollen, red skin. It is caused by too much uric acid in the blood, and attacks are usually treated with an anti-inflammatory such as ibuprofen. See a GP if you have symptoms of gout for the first time.

The NHS describes osteoarthritis as a condition that makes joints painful and stiff. It says you should see your GP if you have persistent symptoms so they can confirm the diagnosis and prescribe any necessary treatment, and that simple measures such as regular exercise, losing weight if overweight and suitable footwear can help mild symptoms.

The NHS says to get help from NHS 111 if you have injured your ankle and it is very painful or the pain is getting worse, there is a large amount of swelling or bruising that is getting worse, it hurts to put weight on it, it feels very stiff or is difficult to move, or you have a very high temperature or feel hot, cold or shivery, which could be an infection.

The NHS says to go to A&E if the ankle is at an odd angle, a bone is sticking out, you have a bad cut or wound, you are in severe pain, or your toes look blue or white or feel numb. It says not to drive to A&E but to ask someone to drive you or call 999.

The NHS also says to see a GP if you think you have a sprain or strain and it is getting worse or not feeling better after treating it yourself.

CKS says assessment of a suspected sprain includes asking about the mechanism and timing of the injury, examining for swelling, joint instability, ability to weight-bear and gait, and considering whether an X-ray is needed to assess the extent of the injury or if a fracture is suspected.

For gout, the NHS says a GP may ask about diet and alcohol and arrange a blood test to measure uric acid, and may refer you to a rheumatologist if the diagnosis is unclear. For osteoarthritis, X-rays or blood tests are not usually necessary but may be used to rule out other causes.

The NHS says that in many areas you can get help such as physiotherapy from NHS community musculoskeletal (MSK) services without needing a referral from a GP. Urgent treatment centres can sometimes arrange an X-ray for a suspected fracture.

Private physiotherapy and orthopaedic consultations are also available, often with shorter waits. The assessment and treatments are broadly the same, and any suspected fracture should be checked promptly through urgent care.