How to diagnose
and treat ankle pain

How do clinicians diagnose ankle pain?

Clinicians start by listening to your story. They will ask where your ankle hurts, when the pain started, whether there was a twist or fall, and what makes symptoms better or worse^{1 3}. They may also ask about your work, sports, shoes, and any medical conditions like gout or arthritis^{1 7 11}.

Next comes a physical exam. Your clinician will look for swelling, bruising, or changes in your foot shape, and will gently press on key spots around the ligaments, tendons, and bones to see what is tender^{1 2 5 15}. They will often check how far your ankle can bend, how strong your calf and foot muscles are, and how steady you feel when you stand on one leg^{1 2 13 14}.

Special tests help narrow down the cause. For example, gentle pulling or tilting of the ankle can suggest a ligament sprain, while a calf squeeze test can help check for an Achilles tendon (heel cord) tear^{1 2}. Standing or walking tests, like a single-leg heel raise, can show if the foot tendons and foot are working well^{1 15}.

For recent injuries, many clinicians use the Ottawa Ankle Rules. These simple checks look at where you are sore on the bones and whether you can take a few steps^{8 9}. If you do not have pain in certain bone spots and can walk, the chance of a broken bone is very low, so an X-ray is often not needed^{8 9 10}.

Imaging is used when it will change care. X-rays are usually the first step if there is concern about a fracture, serious arthritis, or alignment problems^{7 8 10}. If pain continues for several weeks, or there is concern about cartilage damage, tendon tears, or osteochondral lesions, your clinician may order an MRI or ultrasound^{10 15 16}. Ultrasound can be especially helpful to look at moving tendons¹⁵.

Blood tests or joint aspiration are used in a smaller group of people. If your ankle is very hot, red, and swollen, especially with fever or if you are medically vulnerable, your team may take fluid from the joint to rule out infection or gout^{11 12}. This is time sensitive, because untreated septic arthritis (serious infection) can damage the joint quickly¹².

Throughout this process, clinicians also watch for “red flags”. These include major trauma, inability to put weight through the leg, marked deformity, signs of nerve or blood vessel problems, or signs of infection or blood clot^{8 10 12}. If any of these are present, care is more urgent and may involve emergency services^{10 12}.

Clinical insight

For ongoing pain after an initial ankle injury, guidelines suggest starting with a good physical exam and basic imaging, then adding ultrasound or MRI only if symptoms persist, if locking or catching suggests cartilage injury, or if tendon tears or osteochondral lesions are suspected^{1 10 15 16}. This stepwise approach helps you get the right tests at the right time, instead of more testing than you actually need.

What are the treatment options for ankle pain?

Most people recover from sciatica with non-surgical care focused on adequate movement, education, and self-management. Care usually progresses step by step, starting with simple, active strategies and only considering injections or surgery if needed later^{2, 4}.

1. Education and activity Learning that movement is safe and beneficial helps manage stress and anxiety and reduce fear of pain. Gentle movement and gradual return to normal routines promote faster recovery⁴.
   
2. Exercise-based rehabilitation Structured exercise is the foundation of care. Programs often focus on:
   • Repeated movements that “centralize” pain (often gentle back extensions)
   • Core and hip strengthening
   • Nerve mobility work and walking or cycling for enduranceThese programs help restore confidence and function while easing pain^{2, 5}.
3. Medications
   • Anti-inflammatory drugs (NSAIDs) can offer short-term relief, but should be used sparingly due to stomach and kidney risks⁶.
   • Steroid pills show only modest short-term improvement and are not routinely recommended⁷.
   • Gabapentinoids, benzodiazepines, and opioids are not advised for chronic sciatica due to limited benefit and higher risk of harm^{2 8}.
4. Injections Epidural steroid injections may offer short-term pain relief (weeks to months) for severe cases, helping people re-engage with rehabilitation. Effects usually fade over time and risks, while low, include headache, temporary high blood sugar, local infection or tissue damage⁹.
   
5. Surgery If pain remains severe after 6–12 weeks of good conservative care, and MRI confirms a disc pressing on a nerve, microdiscectomy may relieve leg pain. Over the long term (1–5 years), people who choose surgery and those who continue non-surgical care tend to have similar outcomes¹⁰.

Sword's approach

Sword Health helps people manage pain and movement issues with expert-guided AI care you can use from home. Our model combines clinical support with modern technology, designed to work around your life.

Sword makes recovery easier and more accessible. You get high-quality care at home, guided by clinicians and supported by smart technology.

• Care that adapts to your progress in real time
• Licensed experts guiding every step
• Simple, non-invasive, evidence-based programs
• Proven results for pain relief, movement, and satisfaction

How can I find relief for ankle pain?

There are several practical steps most people can try to help calm ankle pain while staying as active as possible. For recent sprains, using a brace or supportive shoe, elevating the leg, and using ice packs for short periods can ease swelling and make it easier to start gentle movement^{1 13}. As pain allows, short walks on level ground and simple range-of-motion exercises, such as ankle circles and gentle up-and-down movements, help the joint stay mobile^{1 13}.

If your pain is more long-standing, regular low-impact activity like walking on flat surfaces, stationary cycling, or swimming can keep the joint moving without overloading it^{7 13}. Many people benefit from simple daily strengthening, such as seated or standing heel raises, toe curls, and balance practice while holding on to a counter^{1 2 13 15}. Wearing supportive, well-fitting shoes and using orthoses (support external devices) when advised can further reduce strain on sore tissues^{2 7 15}.

Pain flares are common and usually mean the ankle was asked to do a bit more than it was ready for, instead of new damage^{1 2 13}. During a flare, it often helps to cut back on high-impact or uneven-surface activities for a few days, return to easier exercises, and gradually build up again^{1 2 7 13}. Simple pain medicine, if safe for you, can sometimes be used short term to help you keep moving^{1 11}.

You should talk to a clinician if pain is severe, not improving over several weeks, or is linked with red-flag signs like fever, major swelling, or trouble putting any weight on the foot^{8 10 12}. A physical therapist or similar movement professional can help create a plan that fits your condition, fitness level, and goals, and can adjust the plan as you progress^{1 2 7 13}.