When most people think about ankle pain, they immediately picture a sprained ankle. But there are loads of other culprits that can leave you hobbling — and some are trickier to diagnose. Whether it’s tendon issues, impingement, or nerve irritation, understanding the full picture is crucial for proper recovery. Let’s dive in! If you want to read more about ankle sprains: CLICK HERE

What Other Injuries Cause Ankle Pain?

While ankle sprains are the classic injury, there are several other conditions that can cause pain here — sometimes even worse than a sprain! Here are some of the big ones we see in the clinic:

1. Ankle Impingement

Impingement happens when soft tissues (like ligaments or tendons) or bony structures get pinched within the joint during movement. It’s a common issue after repeated sprains, but it can also develop from overuse — especially in sports like soccer, netball, and running.

There are two main types:

Signs you might have impingement:

Physiotherapy focuses on restoring normal movement, reducing swelling, and strengthening the surrounding muscles to unload the pinched joint. Early treatment is key to avoiding long-term stiffness or degeneration.

2. Peroneal Tendinopathy

The peroneal tendons run along the outside of your ankle and foot, helping stabilise your balance — especially on uneven ground. Overuse (think running, hiking, or even walking on sand) can lead to tendinopathy, a painful irritation of the tendon.

Common symptoms:

Without treatment, this condition can drag on for months. Physiotherapy focuses on reducing load, strengthening the muscles, and retraining balance to get you back on track.

3. Posterior Tibial Tendinopathy

This injury often masquerades as a vague ache on the inside of the ankle or arch. It’s common in people who do a lot of walking, standing, or running — particularly if they have flat feet or poor footwear.

Signs to watch for:

Treatment usually involves supportive taping, orthotics, strengthening exercises, and sometimes a temporary rest from impact activities.

4. Osteochondral Lesions

Sounds fancy, right? An osteochondral lesion is damage to the cartilage and underlying bone inside the ankle joint, usually following a traumatic injury like a bad sprain or fall.

Key symptoms:

Left untreated, these can cause ongoing issues and even lead to early arthritis. Physiotherapy plays a massive role in restoring mobility and strength after this injury — often helping people avoid surgery.

5. Tarsal Tunnel Syndrome

Think of this as “carpal tunnel” but in your ankle. The tibial nerve runs through a tight space (the tarsal tunnel) on the inside of the ankle, and sometimes it gets compressed.

What you might notice:

Early physio can make a big difference by addressing underlying issues like swelling, biomechanics, or even nerve gliding exercises.

6. Ankle Arthritis

Ankle arthritis isn’t as common as hip or knee arthritis, but it can still wreak havoc — especially after an old injury. It usually develops over years and tends to be more common in people who’ve had multiple sprains, fractures, or high-impact careers (hello, tradies!).

Symptoms include:

Physiotherapy can help maintain ankle mobility, strengthen supporting muscles, and reduce pressure through the joint — delaying the need for surgery as long as possible.

How Physiotherapy Can Help

No matter the cause, getting a proper diagnosis and starting the right rehab early can save you months (or years) of ankle pain. Physiotherapy treatment may include:

✅ Detailed Assessment: Understanding the specific structures involved through movement tests, palpation, and sometimes referral for imaging.

✅ Pain Management: Taping, manual therapy, gentle exercises, and load management strategies.

✅ Strengthening and Balance Exercises: Building strength in the ankle and surrounding muscles (like the calf, glutes, and core) helps prevent future injuries.

✅ Activity Modification: Helping you stay active safely, without aggravating the injury.

✅ Return to Sport or Work Planning: Step-by-step guidance to get you back to full activity without setbacks.

Real Patient Story: Kate’s Journey Back to Hiking

Kate, a 36-year-old outdoor enthusiast, came to see us after feeling persistent pain on the outside of her right ankle. She initially thought it was “just a sprain” after a bushwalk six months earlier, but the pain hadn’t settled despite rest and ice.

After a thorough assessment, we diagnosed her with peroneal tendinopathy — likely aggravated by the uneven trails and her love for minimalist shoes. An ultrasound confirmed mild swelling and thickening of the tendon.

Here’s what her physio plan looked like:

After about 10 weeks, Kate was back hiking pain-free — and she even completed the Coast Track in the Royal National Park without a hitch! She still keeps up with her strength program twice a week to prevent future flare-ups.

Common Mistakes to Avoid

Here are a few things we often see that can stall recovery:

🚫 Pushing through pain too early: Just because you can walk doesn’t mean the ankle is ready for high loads.

🚫 Ignoring strength and balance exercises: These are crucial, even after pain settles.

🚫 Wearing the wrong shoes: Minimalist shoes can be great for some, but when dealing with an injury, a little extra support goes a long way.

🚫 Not seeking help soon enough: Chronic issues are harder to fix than acute ones — early intervention is key!

Final Thoughts

Ankle pain can sneak up in many different forms — not just sprains! Getting a proper diagnosis and starting a tailored rehab plan can be the difference between limping along for months and getting back to doing what you love.

If you’re dealing with stubborn ankle pain, don’t tough it out — book in for an assessment. With the right treatment, you can recover faster, stronger, and smarter.

References and Further Reading

Ankle sprains are some of the most common injuries, making up a significant portion of visits to emergency departments, especially among both the general public and athletes. These injuries can happen to anyone, whether you’re a weekend warrior, a seasoned athlete, or just walking down the street and miss a step. Twisting the ankle inward, known as a lateral sprain, is the most typical type of injury, and without proper management, it can have long-lasting effects. Despite being a common injury, many people underestimate how crucial it is to take care of a sprained ankle, often ignoring it or assuming it will heal on its own. Unfortunately, that’s not always the case, and improper care can lead to recurring problems.

If you’ve sprained your ankle before, you know how frustrating it can be. The immediate pain, swelling, and inability to walk comfortably can throw off your daily routine. And what’s worse is that many people think it’s okay to just “walk it off,” only to face issues down the track. Ankle sprains usually require physiotherapy treatment to achieve the best outcomes. Physiotherapists play a vital role by guiding patients through the rehabilitation process and ensuring they regain full function without the risk of ongoing instability.

the Role of Physiotherapy

Let’s break down what actually happens when you sprain your ankle. When your foot rolls inward, it stretches or tears the ligaments on the outside of your ankle, which are meant to stabilise the joint. These ligaments are like rubber bands holding everything together, and when they’re overstretched or torn, it results in pain, swelling, and often a sense of instability. You might feel like your ankle is going to give way, especially when walking on uneven surfaces.

Now, here’s where physiotherapy comes into the picture. Physiotherapists are trained to assess the severity of the sprain and help you manage the injury in the short and long term. They create tailored treatment plans that not only address the pain and swelling but also work on preventing future sprains. This might involve strengthening the muscles around the ankle, improving your balance, and working on proprioception (your body’s ability to sense movement and position).

Ankle Sprain
Physiotherapist strapping an ankle

The Importance of Early and Proper Treatment

Despite how often ankle sprains happen, it’s surprising that only about 50% of people actually seek medical attention. That’s concerning because when ankle sprains aren’t treated properly, they can lead to chronic instability. This means that you might experience persistent pain, swelling, and even recurrent sprains for months, or sometimes even years, after the initial injury.

In the acute phase, a lateral ankle sprain can cause severe pain and limit your ability to walk. In some cases, there’s even concern about possible fractures, but the good news is that only about 15% of ankle sprain cases involve a fracture. To help healthcare providers assess whether a fracture might be present, there’s something called the Ottawa Ankle Rules. These guidelines are used to determine whether an x-ray is necessary. Interestingly, the most accurate diagnosis of an ankle sprain usually happens around four or five days after the injury when the swelling has reduced, so immediate x-rays or ultrasounds aren’t always needed.

If you’ve just sprained your ankle, you’ll likely be feeling a combination of pain, frustration, and concern about how long it will take to recover. This is where early treatment plays a key role in speeding up the healing process. Instead of waiting for the injury to “go away” on its own, it’s best to get it checked out as soon as possible. The quicker you address the injury, the less likely it is that you’ll deal with ongoing issues.

Physiotherapy: Essential in Managing Ankle Sprains

Let’s dive into the nitty-gritty of how physiotherapy can help. A structured rehab program designed by a physiotherapist can significantly reduce your recovery time and minimise the chance of re-injury. Physiotherapists take a holistic approach to your recovery, focusing on not only the ankle but how the entire body moves and compensates for the injury.

1. Acute Management (First Few Days)

Immediately after the injury, managing pain and swelling is your top priority. The old RICE (Rest, Ice, Compression, Elevation) method is no longer the go-to standard for managing sprains. Instead, we now follow the PEACE and LOVE protocols.

Ankle Sprain

2. Sub-Acute Management (After the First Week)

Once the acute phase has passed, you’ll start moving into what we call the sub-acute phase of rehab. During this time, your physiotherapist will focus on restoring your range of motion, strength, and balance. The goal is to get you moving again without causing more pain.

Ankle Sprain Treatment

3. Late-Stage Rehabilitation (Getting Back to Normal)

In the final stage of rehab, your physiotherapist will focus on returning you to your normal activities, whether that’s going back to sport, work, or just being able to walk without pain. This stage involves more advanced exercises that challenge your balance, coordination, and strength.

Return to Sport/Work: The goal here is to ensure you can safely return to your previous level of activity without the fear of re-injury. This might include exercises that mimic the movements you do in your sport or job, ensuring that your ankle is strong and stable enough to handle the load.

Why Comprehensive Rehabilitation is Key

One of the biggest mistakes people make when recovering from an ankle sprain is not following a structured rehab program. It’s easy to get advice from friends, family, or the internet, but the truth is, everyone’s injury is different. What worked for someone else may not work for you. Without proper guidance, you might be setting yourself up for a longer recovery time or, even worse, repeated sprains in the future.

A well-rounded rehabilitation program is essential for improving your joint’s range of motion, proprioception, and neuromuscular control. These are all fancy terms for ensuring your ankle moves the way it should, you have good balance, and your muscles work together properly. Without these things, you’re more likely to sprain your ankle again.

Physiotherapy doesn’t just focus on the injured ankle. It looks at how your whole body functions and how it compensates for the injury. For instance, if you’re limping because of your sprained ankle, other muscles in your body are working harder to pick up the slack. Your physio will work with you to address these imbalances, ensuring your entire body is functioning optimally.

The Role of Manual Therapy

Manual therapy can be a helpful part of the rehabilitation process, but it’s not a magic fix. It’s important to understand that while things like massage, joint mobilisation, and soft tissue work can provide temporary relief, they need to be combined with an exercise-based rehab program for long-term results. Your physio will use manual therapy techniques to help reduce pain and improve mobility, but the real progress comes from doing the prescribed exercises.

Ankle massage

Conclusion

Ankle sprains are more than just a minor inconvenience – they require proper attention and care to prevent long-term issues. Physiotherapy is vital in managing these injuries from the acute phase through to full recovery. By following evidence-based guidelines and working with a qualified physiotherapist, you can expect better outcomes, reduced risk of chronic instability, and a smoother return to your daily activities.

If you’ve recently sprained your ankle, don’t hesitate to reach out for professional help. Our team at XPhysio Frenchs Forest are experts when it comes to this. Give us a call today – we’re here to guide you through every step of the way and get you back on your feet as soon as possible!