Ankle pain when turning inward indicates an injury to the ankle’s structures during an inversion movement. This pain often results from activities or missteps that cause the foot to roll.
Common Causes of Inward Ankle Pain
The most frequent cause of pain when the ankle turns inward is an inversion ankle sprain. This injury occurs when the foot rolls excessively inward, stretching or tearing the ligaments on the outside of the ankle, such as the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL). Such sprains often happen during activities involving rapid changes in direction, landing incorrectly after a jump, or stepping on uneven surfaces. Symptoms typically include sudden, sharp pain on the outside of the ankle, swelling, bruising, and difficulty bearing weight.
Another source of pain with inward ankle movement involves the peroneal tendons. Inflammation (peroneal tendinitis) or tears can cause pain on the back and outside of the ankle that worsens with foot inversion. Overuse, improper footwear, or recurrent ankle sprains commonly contribute to these issues. Patients with high arches may also be more prone due to increased strain.
Sinus Tarsi Syndrome is characterized by painful swelling in the sinus tarsi, a canal between the ankle and heel bones on the foot’s outside. This syndrome commonly develops after an ankle sprain, especially if recurrent. Pain and swelling are typically felt on the lower outside edge of the ankle, often with instability and increased discomfort during inversion or walking on uneven ground.
Osteochondral lesions of the talus (OLTs) can also contribute to ankle pain, especially with weight-bearing activities. These injuries to the cartilage and underlying bone often result from traumatic ankle injuries like sprains. Pain is often worse with standing or activity, and clicking or popping sounds may be present. Anterolateral lesions are particularly associated with twisting injuries.
Immediate Steps for Ankle Pain
Immediate self-care measures can help manage ankle pain and promote initial healing. The R.I.C.E. protocol is a widely recommended first step, involving Rest, Ice, Compression, and Elevation. Resting the injured ankle means avoiding activities that aggravate the pain and limiting weight-bearing.
Apply ice to the injured area for 15 to 20 minutes, several times daily, to reduce swelling and pain. Place a thin towel between the ice pack and skin to prevent damage. Compression, using an elastic bandage wrapped snugly around the ankle, helps control swelling. Wrap the bandage from toes to calf, ensuring it is not too tight to cause numbness or increased pain. Elevate the ankle above heart level, especially when sitting or lying down, to further reduce swelling.
Over-the-counter pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, can help manage pain and inflammation. Use these medications according to package directions, and consult a healthcare provider if uncertain.
When to Seek Professional Medical Attention
While many ankle injuries can be managed with self-care, certain signs indicate the need for professional medical evaluation. Seek immediate medical attention if you experience severe pain or swelling that prevents you from putting any weight on the ankle. A visible deformity, unusual bruising, or a popping or grinding noise heard at the time of injury also warrant prompt medical assessment, as these can suggest a more serious injury like a fracture.
Numbness or tingling sensations in the foot or toes are concerning symptoms that require a doctor’s visit, as they might indicate nerve involvement. If the pain does not improve with self-care measures after a few days, or if it worsens over time, it is important to consult a healthcare professional. Recurrent pain or instability when turning the ankle inward, even after previous injuries, also suggests the need for medical evaluation to prevent long-term issues.
Diagnosis and Treatment Approaches
A healthcare professional will begin diagnosis with a medical history and physical examination of the ankle, foot, and lower leg. They will check for tenderness, swelling, and assess range of motion to determine affected ligaments or structures. Imaging tests may be ordered to further investigate. X-rays often rule out bone fractures, while magnetic resonance imaging (MRI) provides detailed images of soft tissues like ligaments and tendons. In some cases, a CT scan may be used for complex bone structures, or an ultrasound for real-time soft tissue assessment.
Conservative treatments are often the first approach for ankle pain. Physical therapy is key to recovery, focusing on exercises to improve strength, flexibility, balance, and ankle range of motion. Therapists may guide patients through gait training to normalize walking patterns and recommend bracing or taping for support and stability during healing. Medications, including non-steroidal anti-inflammatory drugs (NSAIDs), may also be prescribed to manage pain and inflammation.
Surgery is considered for severe ankle injuries or when conservative treatments fail. This includes chronic ankle instability from torn ligaments, certain osteochondral lesions, or persistent peroneal tendon issues. Surgical procedures aim to repair damaged structures, restore stability, and alleviate chronic pain, though approaches vary by condition. Following surgery, a period of non-weight bearing and physical therapy is typically required for recovery.