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ankle pain

AUTHOR: Marc Mitnick DPM

REVIEWED BY: Podiatric Medical Review Board

--> ankle pain

sharp pain in and around the ankle for no apparent reason


Are you having sharp pain in your ankle and cannot figure out why? In your case there is no history of trauma, you are not especially active or athletic but you seem to have ankle pain, mainly on the inside or the outside of the ankle. You may or may not be overweight. You have been to the doctor, perhaps had x-rays, had various types of treatment but still have pain.

This discussion deals with one aspect of a painful ankle that most non-footspecialists would fail to recognize. It deals with pain that is the result of nothing more than abnormal biomechanics of the foot. Biomechanics is defined as "The study of the mechanics of a living body, especially of the forces exerted by muscles and gravity on the skeletal structure." More simply stated, it is the way the body functions in regard to the musculoskeletal system.

Unfortunately, most of us do not function the way the anatomy books would lead us to believe. There are many variations on the way the skeletal system is “supposed" to function. Most of these variations would be considered normal since there is a large percentage of the population that exhibits these variations. A simple example would be a limb length discrepancy where one limb is slightly shorter than the other. It is abnormal compared to an anatomy text book but normal in that many people exhibit that trait.

In regards to the ankle joint, this joint is considered a hinge joint where the talus bone of the foot sits directly under the tibia bone and is anchored on the side by the end of the fibular bone to form the ankle joint. This type of joint allows the foot to move up and down.

Look at the picture below, notice how the talus bone of the foot sits perfectly under the tibia and fibula bones of the leg. Also, note the perfect space between the talus bone and the tibia and fibula bones; this is an ideal articulation which forms the ankle joint. Under these circumstances, without any history of trauma there would be no complaints of ankle pain.


normal ankle

One of the biomechanical faults that many people exhibit is that of over-pronation. I mention over-pronation because most people pronate to some degree. See pronation and the gait cycle to help understand ankle pain

The picture below exhibits a foot that is excessively pronated. The problem with this is that the excessive pronation forces the talus bone to abnormally sit in the joint space. Over time this will cause a premature erosion of the joint, in the same manner that unbalanced tires on a car will cause premature erosion of the tread on the tires.

pronation foot


pain on the outside of the ankle

lateral ankle pain

In its simplest form, excessive pronation, will cause arthritic changes to occur within the ankle joint, eventually leading to ankle pain, but not the type of ankle pain that we are discussing in this section.

What also happens is that due to the abnormal alignment of the talus bone in the joint, the outside of talus bone will impinge or press into the end of the fibula bone. Note the blue arrow. This will cause a constant jamming and irritation on the soft tissue in that area, primarily the ligaments that attach the two bones (lateral ankle ligaments).

The peroneal tendons are two tendons that come down the outside of the lower leg and travel under the lateral malleolus (the outside ankle bone). Because of the over pronation and jamming effect, these tendons can get caught up in the impingement. Typically the outside of the ankle will be swollen as well. Damage to the tendons can be as simple as an irritation, all the way to a partial tear in the tendon. This degree of damage will in many cases respond to conservative care, but sometimes the tear in the peroneal tendon must be surgically repaired.

What will typically happen is a patient will present to the office complaining of ankle pain on the outside of the ankle; there is no history of trauma, the patient may not be very active or athletic, but it seems the pain just came about out of nowhere and is a nagging type pain. Many people will also complain of burning on the outside of the ankle as well.

The sural nerve is a nerve that also passes just below the outside part of the ankle and this nerve may get "pinched" and will result in a burning sharp pain in ankle. The patient has been to another doctor who prescribed anti-inflammatory medication, possibly gave a cortisone injection, may even have tried physical therapy or even immobilization of the ankle all in an effort to reduce the pain. In most cases the ankle may even have felt somewhat better while undergoing treatment but once the treatment ended, the pain returned.

pain on the inside of the ankle

medial ankle pain

Now, if you are over-pronating and you are jamming the bones on the outside of the ankle, what do you think you are doing on the inside of the ankle? You are doing the exact opposite; you are stretching the soft tissue structures between the talus and the tibia. Note the red arrow in the drawing above. There are two major problems that can occur on the inside of the ankle. The first is a tarsal tunnel.

The second major problem is what is known as PTTD, otherwise known as posterior tibial tendon dysfunction. The posterior tibial muscles originates in the back of the leg, the tendon then passes below the inside bone of the ankle, the medial malleolus, and attaches into the navicular bone which is a bone on the inside of the foot. The purpose of this muscle is to support the arch of the foot. In situations where there is too much pronation, the tendon essentially gets stretched out and becomes inflamed, along with losing its ability to support the arch.

When the scenario of pain either on the inside or outside of the ankle presents itself, with no history of trauma, the very first thing I ask the patient to do is stand up. If I notice excessive pronation and by pressing into the crease at the level of the skin on the outside of the ankle, or pressing on the stretched skin on the inside of the ankle, that is caused by the pronation, and the patient states that is where it hurts, I am fairly certain of the diagnosis.


Treatment is very simple. Reduce or eliminate the excessive pronation.

1. In very minor cases of pronation, a medial heel wedge added to the shoe will force the heel into inversion (the opposite of eversion which is seen in pronation), basically to realign the talus within the ankle joint. This type of treatment is more effective for mild cases of ankle pain. A medial heel wedge can be purchased online, in a surgical supply store, or even a shoe repair store. You just place it under the inside portion of your heel.

2. Another simple solution may be the use of an orthotic. The orthotic is better than a heel wedge simply because it forces the whole foot out of pronation. Keep in mind if you do not feel the support of the orthotic under your arch, then it probably is not helping.

3. A more permanent solution, and one used in more severe cases of pronation (and thus ankle pain) is to make a prescription orthotic with an exterior varus post, which has the same effect as a medial heel wedge, to keep the foot and ankle properly aligned, and to raise the arch to reduce the strain on the tibialis posterior muscle. This treatment works like magic. Within a day or so the patient will begin to notice improvement and over the course of a couple of weeks the pain will dramatically diminish.

In the initial stages the patient must wear the orthotics all the time. Some people will wear them during the day, kick off their shoes as soon as they get home and then wonder why their ankle still hurts. Walking barefoot exacerbates this problem, so the orthotics must be worn all the time, from the time you wake up until the time you go to bed, until the pain is gone and then the patient can start going barefoot more frequently around the house.

4. Once the excessive pronation has been eliminated, additional therapies such as physical therapy, or oral anti-inflammatory medication may be supplemented in an effort to reduce the pain in the more resistant and chronic cases.


The opposite of pronation is supination and therefore one might think that in excessive supination the opposite ankle symptoms would occur. In theory yes, in practice, rarely. The reason is that excessive supination is rarely seen in the general public, it is much more prevalent in people with neurological disease. Since those with neurological disease affecting the legs tend to exhibit an abnormal gait to begin with it is rare to see someone in that situation come in with just ankle pain.

People who have very high arches, cavus type foot, also have a tendency to supinate more but they too usually do not present with the kind of ankle pain discussed in this section.

see related article....ankle sprain

see related article....flat feet


Mayo Clinic


Cleveland Clinic

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ORTHOTICS for multiple types of foot pain
best buy in a pre-made orthotic
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ORTHOTICS for heel and arch pain for those who must wear dress shoes
click link below


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….after reviewing your amazing site (great for the avg. jill). So thank you very much!!!


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(location unknown)
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New York
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Thanks again so much for the information in the article. Very interesting.


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J. Simmons

(location unknown)
Dear Dr. Mitnick, The orthotics arrived four days ago and I slipped them into my shoes immediately. I was skeptical as to the usefulness of the item, they really didn't look very exotic. I have to say though, after using them for just four days, I have experienced grand relief from my foot pain. Even the very first day, I was able to do a lot of work while on my feet with at least a 75% reduction of pain. It has only gotten better every day, and I go nowhere without my shoes with the orthotics. I had been experiencing extreme heel and sole pain for about six months and had to take extended breaks off my feet many times a day as well as regular doses of Ibuprofen. Since getting the orthotics, my life has returned to normal and I feel good again. Just wanted to say thanks for the recommendation for a very effective item, I had no idea what a change this item could affect.

Yours truly,

J.C. Forbes

Thanks for the Response, you hit it on the head.


Redondo Beach, CA
Thank you for your time and expertise in answering my question…..


(location unknown)
First, thanks for putting together this website. Its the most informative site I have found dealing with foot problems. Last June I started having pain and swelling at …….


(location unknown)
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Pete M.

(location unknown)
Thank you for the best site I have found when researching foot pain.

Glenda B.

Madison, Alabama
Thanks for replying so quickly. I was a bit concerned. I think your website is great, and chock full of info.....


Denison, TX
Dr. Marc, Thank you so much for your reply which seemed to be right on. I have researched many sites but you put me on the right path to the possible answer. My foot pain may not rule the rest of my life after all! I believe I'll make a sign that reads, "THE END IS NEAR!" Thanks Very Much,


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Tampa, Florida 33624
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Just a wee word of thanks for your wonderful website...It is a terrific service...Thank you for providing your knowledge and help...With highest regards, m ebeling

Michael D. Ebeling

Tampa, Florida 33624

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Dear Dr.Mitnick

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I thank you for putting together this incredible website.


Dragica W.


....I have been told that it is not hard enough to be cut off. Please help, I am not sure what to do now! THANKS FOR A WONDERFUL AND VERY HELPFUL SITE!


South Africa

You have an unusually clear, informative and well-written website for laypersons. Thank you for that.

Matthew W.

Mansfield Ctr, CT

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Placentia, California

First, I want to let you know that you have the best web site I've found related to foot issues. (The only thing I had difficulty finding was the "ask a question" page.)


Unknown location

I received the orthotics Monday afternoon and began wearing them Tuesday. After two days I would say that I have noticed a huge improvement in the discomfort I have been experiencing. My foot feels better than it has in months.

Ric J.

Unknown location

I greatly admire someone like you who would donate and dedicate so much time and effort to helping strangers with no compensation. Truly, it is uncommonly kind. And your site is so intelligently arranged.

Ron R.

Pacific Grove, CA

I used to work for a podiatrist (front desk) back during summers in college years ago, so I know the benefits of good care. Again, I want to thank you for an EXCELLENT website. It was so great to get to your site (top of google search) and actually find all the answers I needed EASILY and QUICKLY! Clearly you put a ton of work into it and I really appreciate it.

All the best,


Alameda, California

By the way, millions of websites could use yours as a guideline on how to organize information and make the site user-friendly. Kudos to you!


Thank you for your very interesting and informative site!


Hi. I come to your site often looking for information. It is really informative and I appreciate it very much. I have RA and have been having considerable amount of foot pain...... Dee RN

Thanks very much for the wonderful informative site.


New Zealand

Thank You for my answer! I have been schedule for a bone density scan, allingment, and I am in the process of getting orthotics made, and checking out the natural remedies. Thank again! What a great web site!



Yes I want both pair of orthotics. You don't have an option of ordering 2 at one time so I had to place the order twice. Thanks. My husband likes these and wants to put them in all of his shoes. (referring to Superstep orthotics)

Cindy H.

I searched the internet everywhere for a clear description and illustration of my symptoms/problem. was where I ended my search with answers. If I lived in Jersey (left 30 years ago) and didn't live in Florida I would definetly make an appointment with Dr. Mitnick.

Thanks, Kathy

1st of all THANKS A LOT for your great site......


Thank you so much for your response. I will let you know how I am doing if you would like. Your website is awesome!


South Carolina
Hello! I want to thank you for such an informative website! I found you based on my ankle pain search and am happy to realize that there may be a relatively simple cause and solution....


unknown location

...Thanks for your fantastic service.


Arlington, VA

Thank you so very much, that would be much appreciated. I love those insoles, by the way. (referring to Superstep orthotics)

Kelly W.

San Clemente, CA

Dr Marc is fantastic...He seems to know exactly what you are feeling with the problems you are having. I wish he was in my home town so I could go to him with my problems!!!!!!!!!!!!!


location unknown

Great insights! Thanks Doc, you're the best.


location unknown

I have been experiencing foot pain of various sorts and am working to figure out what it is. I found this site and can only say BRAVO!! What an excellent site! The time it must have taken to put all this together must've been a daunting task! I am sure it has helped so many people. Thank you so very much for doing this.


location unknown

Dr. Mitnick, Thank you so much for your reply. I did let my physician know and they took an x-ray - all is well! Also, thank you for providing this wonderful site, it is very helpful with lots of useful information! I appreciate your gift of time! God bless.


Dr. Mitnick, Thank you, you were 100% correct. The pain finally brought me to the ER. I spent 8 days in the hospital. The Doppler you spoke of was able to show that there was no pulse in that foot. This was an arterial clot that split and traveled throughout my leg. My leg was almost amputated. I am in rough shape but have all my parts intact!! You certainly know what you are talking about. Thank you for taking the time to answer. Yours Truly!


Staying at home after hallux surgery I spend quite a lot of time seaching info useful for avoiding problems which might come back. Today I found your site and I am .... delighted it happened. It's one of the best site I found last days.



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Seattle, WA

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location unknown

Also, and importantly, just want to praise this web site. Thorough and thoughtfully presented, it certainly must be of considerable assistance to anyone with a foot problem. Terrific -- and very interesting.I trust the address comes up easily for those seeking information.


New Jersey

Thanks so much for answering my question. You've been more help to me than my own Dr. has been lately. Thanks again....I hope to be able to walk without pain someday.


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Wow, that is exactly the information needed!!! thank you thank you thank you!!! I appreciate this help so very much from Marc Mitnick DPM. Excellent information and help to improve One's life.


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Thanks so much for this website Dr. Marc! It is so nice that you have this ask the doctor feature..I'm sure I'ts been helpful for alot of people. I will try what you suggested and see if it helps...thanks again!


Evansville, IA

Dear Marc

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Russ W.

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Your website is full of a lot of helpful information, and I am very impressed with the time in which you responded to my post. Thank you again for your time and consideration in your response.


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Thank you very much for the information, I will consider it. Excellent web site.


San Diego, CA

Dr. Mitnick, Just want to say thank you so very much for your quick response and very informative reply! After reading what you had to say, I called the doctor's office and was able to get in and see him the same day as my injury. Toe was x-rayed and luckily, it is not broken or fractured. Very badly bruised and will probably lose the toe nail. And although my toe and toe nail are still very black and blue and very sore, they ARE both starting to feel a little better. So again, thank you! I am so very happy that I came across your website. The service you provide is outstanding and immeasurable!


Albany, NY

Thank you so much for all of your advice. In searching the web for people dealing with this same issue i can tell you that you are a Knight In shining Armor! If I lived in Jersey I would gladly be your Spokesperson. Hopefully next time you hear from me it will be good news. God Bless,

Jill S.

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Whichita, KS

thanks again, this site is very helpful.


Boston, MA

Like others have stated...This site is amazing and I am so thankful that it was created.

....Keep up what your doing. Your a life saver.



Thanks again for the information provided on your site. It's easy for non-medical folk to understand your writing, and helps provide better communication between patient and doctor.



Wonderful advice

by: Anonymous

This is the best site for foot problem info.

Thank you for this information. This description fits my pain and inflammation behind my 2nd toe perfectly.

by: Max

location unknown
Again, I really appreciate that you responded to my inquiry, and that your mention of Parkinson's helped me to find my way to a diagnosis of this difficult to diagnose disease. Most patients see on average 16 doctors before they are diagnosed. I hope that you can help other people that ask for your expertise in the future.

Barb D.

I just wanted to say that I am very greatful for this website!! I have had a fusion in my rt foot and am finally getting a little bit better......


location unknown
Again, Thank you from the bottom of my heart for taking the time to answer my question....your an angel!


Thank you for your response. You have provided some great insight (to my question)....


location unknown
Thank-you so very much for responding so quickly and in such detail to my question!! I will give my surgeon a call today!! This website is terrific!!!! Thank-you again!


North Carolina
Many Thanks Dr Marc!
Thank you for your response. It sounds like a good plan to me. He did not cut the wart out first ...


location unknown

Thanks again doc for having this website and we STILL need qualified Podiatrists in beautiful sunny Tampa Bay (Bradenton) Florida.

Bessie Mae

Dear Dr. Mitnick, Thank you so very much for taking your time to answer my question. You have greatly relieved my anxiety related to the continual tingly I feel in my feet. I will share your response with my podiatrist next week. God bless you for having this question and answer page on your website! Most gratefully,

Lynne T.

location unknown
Your webpage is excellent, I commend you on sharing your knowledge to the public.


New Jersey

Thank you. you were more detailed than what others have told me they finally called from the last xrays and my son is now in a cast for 2 weeks he did have a fracture that was not noticeable.

a mom

location unknown

I have read your website and I have to admit that I am amazed at all the information that is on here. I have learned more than the three years I have been going to several doctors that I have seen!!


Lenoir, NC

Thank you so much Doc for a quick and thorough response!


Bellevue, WA

I cannot thank you enough for your response, opinion, and suggestions! I want you to know how much it means to me, and I'm sure everyone else who has ever asked you a question! I feel like you're a lifesaver and have empowered me to take a stronger role and stand up for myself and my feet!


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