Yes, neuropathy can cause ankle pain. Neuropathy is a condition resulting from damage or dysfunction of the nerves outside of the brain and spinal cord. This nerve damage can occur anywhere in the body, but it frequently affects the feet and ankles because these areas contain the body’s longest nerve pathways. When these nerves are compromised, the signals they send back to the brain are scrambled, leading to pain and altered sensations. While ankle pain is often assumed to be a problem with bones, ligaments, or tendons, a nerve issue must be considered, especially if the discomfort is chronic or presents unusually.
The Mechanism of Neuropathic Ankle Pain
Neuropathic ankle pain stems from a disruption in the way sensory nerves transmit information to the central nervous system. The peripheral nerves in the foot and ankle, particularly the tibial and fibular nerves, relay sensations like touch, temperature, and pain. When these nerves are damaged, their electrical signaling becomes erratic, often resulting in a misinterpretation of signals. Instead of simply reporting a sensation, the damaged nerve fibers spontaneously fire or send exaggerated pain signals.
The pain signals generated in neuropathy are not a response to a physical injury in the joint itself; they result from the nerve structure being compromised. This damage can involve the myelin sheath, which insulates the nerve, or the axon, the long fiber that transmits the signal. Sensory nerve involvement is the primary driver of neuropathic pain, causing altered feelings in the skin and tissues around the ankle. Motor nerves, which control muscle movement, and autonomic nerves, which regulate involuntary functions, can also be affected, potentially leading to weakness or changes in skin function.
How Neuropathy Pain Feels in the Ankle
Neuropathic pain in the ankle is typically described as a constant, deep-seated burning sensation, which is a hallmark of nerve-related discomfort. This burning often concentrates around the ankle and can radiate into the foot or lower leg, sometimes intensifying at night.
Sharp, shooting pains that feel like sudden electric shocks or jabbing sensations are also commonly reported, often occurring without an external trigger. Another frequent symptom is paresthesia, described as a tingling, prickling, or “pins and needles” feeling, or the sensation of constantly wearing a sock when the foot is bare. Heightened sensitivity to touch, medically termed allodynia, can make mundane actions like wearing shoes or having a bedsheet rest on the ankle intensely painful. If motor nerves are involved, a person may also experience muscle weakness or a lack of coordination, which can affect balance and walking.
Underlying Conditions That Cause Ankle Neuropathy
Ankle neuropathy can arise from systemic diseases that damage nerves throughout the body or from localized issues that compress a single nerve. The most frequent systemic cause is diabetic neuropathy, where chronically high blood sugar levels impair nerve function, often affecting the longest nerves first, which are those that reach the feet and ankles. Other systemic conditions that lead to widespread peripheral nerve damage include:
- Autoimmune disorders
- Chronic alcohol use
- Kidney disease
- Side effects from chemotherapy
Local nerve compression at the ankle is known as an entrapment neuropathy. Tarsal Tunnel Syndrome (TTS) is a localized condition where the posterior tibial nerve is compressed as it passes through a narrow channel on the inside of the ankle. This compression can be caused by swelling from an ankle sprain, a structural abnormality like flat feet, or space-occupying lesions such as a ganglion cyst or bone spur. Trauma, such as a severe ankle sprain or fracture, can also directly injure or cause inflammation that compresses nerve structures.
Distinguishing Neuropathic Pain from Structural Ankle Injuries
Structural ankle pain, caused by damage to ligaments, tendons, or bone, is usually localized directly at the site of injury and worsens with movement or weight-bearing. This type of pain is often accompanied by visible signs of inflammation, such as swelling, bruising, and tenderness to the touch.
In contrast, neuropathic pain often lacks these objective signs of swelling or bruising and can feel disproportionate to physical movement. The pain may be constant, even at rest, and can be triggered by non-painful stimuli like light touch, which would not affect a sprained ligament. Systemic neuropathies often cause symptoms in both ankles simultaneously, whereas a structural injury is typically confined to one side. A sensation of numbness or the presence of electric-shock feelings strongly suggests nerve involvement rather than a purely mechanical problem.