There are a number of structures around the ankle that can cause pain and to identify which one is affecting you there are a few questions that we need to ask:

1. Where is the pain?

Pain at the back of the ankle is most likely to be originating from the Achilles tendon (Achilles tendinopathy). The heel bone (or calcaneus) and the back of the ankle joint (tibiotalar joint) can also cause symptoms in injuries such as stress fractures or posterior ankle impingement. Symptoms at the side will often occur following ligament damage (ankle sprains). and at the front (into the shin region) syndesmosis injuries, stress fractures and ‘shin splints’ are a common diagnosis. Non-specific pain that is difficult to localize can occur with ankle instability following repeated ankle sprains. Pain can also be referred from other sources e.g. the back or knee or from general joint pathologies such as osteoarthritis.

2. How and when did the pain start?

Did you suffer a trauma to the ankle i.e. a fall, tackle or sudden twist or hit? Ankle sprains most commonly cause ligament damage but in more severe cases bone (fractures) and cartilage (osteochondral defects) can be damaged. If the injury is more gradual in onset this is often related to overuse or overload and can cause tendon pain (Achilles tendinopathy, peroneal tendinopathy) or joint irritation as seen with anterior ankle impingement.

3. What type of pain are you getting?

Sharp, stabbing pain is more frequently described with traumas to the affected joint, ligaments or surrounding muscles (ankle sprains, fractures). A dull, tooth ache or throbbing pain in a very general sense is attributed to overuse injuries effecting tendons or soft tissues. Pins and needles, zinging or numbness are signs of nerve irritation and this can be a problem locally (around the ankle) or from a different source e.g. the lower back.