Sudden Ankle Pain Without Injury: 8 Possible Causes

Sometimes ankle pain arises out of the blue. You may notice that your ankle is aching but cannot remember how you injured it. Ankle pain is usually the result of an injury, but it can also occur spontaneously due to conditions such as arthritis, gout, or an autoimmune disease.[1]

Symptoms of Ankle Pain

The symptoms of ankle pain depend on the structure that is affected. Ankle stiffness and swelling are common with arthritis, making it difficult to put weight on the joint. Other symptoms of spontaneous ankle pain include muscle pain and clicking or popping sounds.

What Causes Ankle Pain Without an Injury?

The causes of spontaneous ankle pain are numerous, ranging from different types of degenerative disease, such as arthritis, to autoimmune diseases like lupus, gout, cartilage lesions, and infections.

See below for more details on the possible causes and treatments of spontaneous ankle pain:

1. Osteoarthritis

Osteoarthritis is a degenerative disease that can affect any joint and typically occurs in older people.[2] It is essentially a wearing down of the cartilage between the joint surfaces, exposing the underlying bones. Osteoarthritis in the ankle is characterised by pain and stiffness, which is worse in the morning.

Unfortunately, osteoarthritis cannot be cured, but it can be managed. Your doctor will likely prescribe non-steroidal anti-inflammatories such as ibuprofen. In severe cases, cortisone may be injected into the joint to relieve pain and inflammation. Physiotherapy is also effective for improving movement and strengthening the various muscles surrounding the joint. In severe cases, surgery such as an ankle fusion or ankle replacement may be indicated.

2. Rheumatoid Arthritis

An autoimmune disease, rheumatoid arthritis is a progressive condition where the body’s immune system attacks its tissues.[3] Rheumatoid arthritis affects the joint linings, causing chronic inflammation and pain. Over long periods, rheumatoid arthritis can cause severe joint deformity in the feet and ankles.

Depending on the severity, rheumatoid arthritis is typically treated with prescription medications such as disease-modifying antirheumatic drugs (DMARDs), however it cannot be cured. Cortisone injections may also be prescribed in addition to over the counter pain relievers. Physiotherapy effectively ensures that the ankle joints are moving effectively and in relieving pain associated with rheumatoid arthritis.

3. Gout

Gout is a form of arthritis that occurs from the build-up of uric acid in your joints. Although the big toes are the most common gout sites, it can also affect the ankle joints.[4] The symptoms of gout include severe swelling and redness in the joint, which occur suddenly and often develop overnight. Gout is caused by high levels of uric acid that accumulate in the joints. Your body produces uric acid when it breaks down purines - substances found in red meats, organ meats such as liver, purine-rich seafoods, and alcohol.

Gout is often treated with anti-inflammatory medications such as non-steroidal anti-inflammatories. It can also be treated with corticosteroids or colchicine, an anti-gout medication. Additionally, it is important to watch your diet, avoiding alcohol, red meat, and purine-rich seafoods, such as anchovies, trout, and tuna fish.

4. Achilles Tendonitis

Achilles Tendonitis is a condition where the Achilles Tendon, which attaches the calf muscle to the heel bone, becomes painful and inflamed. Although injuries can cause Achilles tendonitis, repetitive movements such as running or walking can damage the tendon. The symptoms of Achilles Tendonitis include swelling or pain in the back of the heel that can refer to the ankle.[5] The pain is worse with walking or running.

The treatment for Achilles Tendonitis includes rest, ice, and non-steroidal anti-inflammatories. Physiotherapy also provides pain relief through mobilisation, massage, dry needling, stretching, and specific strengthening exercises.

5. Flat Feet

Flat feet or pes planus occurs when the tendons supporting the inside arch of your feet collapse. Flat feet are caused by numerous conditions, including obesity, arthritis, and pregnancy. When the arch collapses, it puts strain on the structures on the inside of the ankle, causing pain and inflammation, which can eventually lead to arthritis.

Flat feet are usually treated with orthotics or inserts in the shoe to improve the ankle and foot position. Pain-relieving medications and non-steroidal anti-inflammatories may also be prescribed to improve pain in the ankle region. Other recommended treatments include physiotherapy to strengthen the muscles that support the arches.

6. Ankle Bursitis

Bursae are the fluid-filled sacs that cushion the ankle bones, preventing friction. These fluid-filled sacs can become irritated and inflamed from overuse due to excessive walking, running or weight-bearing. Conditions such as gout and arthritis may also contribute to the development of bursitis.

The treatment of bursitis involves reducing the pressure on the bursae through rest and the use of non-steroidal anti-inflammatories. A splint or compression bandage may also be applied. In severe cases, your doctor may decide to drain the bursae using a needle and syringe.

7. Lupus

Lupus is an autoimmune disease that causes inflammation of the joints in the body, including the ankle.[6] Lupus is a life-long condition that results in swelling, joint and muscle pain, but only present during a flare-up.

Unfortunately, lupus cannot be cured, but it can be managed. Current treatment focuses on minimising flare-ups and managing the symptoms. Rest and non-steroidal anti-inflammatories will help reduce the pain and inflammation during an episode. Other lifestyle factors, such as exercising regularly and eating a healthy, balanced diet, are recommended to reduce flare-ups.

8. Osteochondral Lesions of the Talus (OLT)

Osteochondral lesions of the talus (OLT) often develops after a previous injury to the ankle region. It is an area of abnormal, damaged cartilage that causes a clicking or popping sound, which may result in the ankle becoming “locked” in a certain position.

The treatment for OLT includes rest from any running or jumping activities, non-steroidal anti-inflammatories, and physiotherapy to improve the joint's mobility. In severe cases, or if the condition has not improved within 3 - 6 months of beginning treatment, surgery may be indicated to remove or repair any loose cartilage.

Diagnosing Spontaneous Ankle Pain

The diagnosis of spontaneous ankle pain includes visiting a doctor or physiotherapist who will ask you about your medical history and what symptoms you are experiencing. They will also perform a detailed physical examination.

In some cases, you may be referred for further investigation, including an X-ray to rule out a bone fracture or an ultrasound scan to check for damage to the tendons or muscles. A CT scan may also be necessary to detect any joint issues.

Additionally, if you have previously had an ankle injury or have been diagnosed with a condition such as lupus or rheumatoid arthritis, your doctor may have a better idea of what may be contributing to your ankle pain.

Outlook

Spontaneous ankle pain can develop without injury. Many conditions can result in ankle pain, including various degenerative conditions, such as arthritis, autoimmune diseases, or structural deformities, such as flat feet. Visit a doctor or physiotherapist if your pain is persistent, it may be a sign of a more serious underlying condition.