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Ankle Pain Without Injury: Causes, Symptoms & When to See a Doctor

Non-traumatic ankle pain often stems from overuse, biomechanics, or systemic disease.

Common Causes

  • Tendinopathy: Achilles (insertional/midportion), posterior tibial, peroneal. Load-related; morning stiffness.
  • Impingement syndromes: Anterior (dorsiflexion), posterior (plantarflexion) – osteophytes/soft tissue.
  • Arthritis: Osteoarthritis (post-traumatic), rheumatoid, gout (acute monoarticular), psoriatic, reactive.
  • Stress fracture: Navicular, talus, distal fibula – insidious onset, activity-related.
  • Plantar fasciitis: Medial heel pain radiating to arch/ankle.
  • Tarsal tunnel syndrome: Tibial nerve compression → burning, tingling, medial ankle/sole.
  • Sinus tarsi syndrome: Lateral ankle instability/pain; subtalar joint.
  • Accessory ossicles: Os trigonum (posterior), os naviculare (medial) – symptomatic with activity.
  • Foot posture: Pes planus (overpronation) or pes cavus → altered load distribution.
  • Referred pain: Lumbar radiculopathy (S1), knee pathology.
  • Vascular: Popliteal artery entrapment, DVT (calf/ankle swelling).
  • Infection: Septic arthritis, osteomyelitis (rare without trauma/surgery).

Red Flags

  • Inability to bear weight.
  • Severe swelling, heat, redness.
  • Fever, chills.
  • Neurologic deficit (foot drop, numbness).
  • History of malignancy.

Evaluation

  1. History: onset, timing, aggravating/alleviating factors, footwear, activity change.
  2. Exam: gait, ROM, palpation, special tests (Thompson, anterior drawer, Tinel's).
  3. Imaging: Weight-bearing X-rays (AP, lateral, mortise); MRI/US for soft tissue; CT for bony detail.
  4. Labs: ESR/CRP, uric acid, CBC if inflammatory/infectious suspected.

Conservative Management

  • Activity modification, NSAIDs, physical therapy (eccentric loading, proprioception, gait retraining).
  • Orthotics, bracing, footwear modification.
  • Corticosteroid injection (judicious, avoid tendon).
  • Shockwave therapy (tendinopathy).

Persistent >2–4 weeks despite conservative care → orthopedic/sports medicine referral.

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