Ankle pain: sprained ankle, heel pain, or tendonitis?
Written by Leann Poston, M.D.
Ankle sprains are the most prevalent injury of the musculoskeletal system, with an estimated one ankle sprain per 10,000 people each day. The ankles and feet support the weight of the body and are prone to overuse injuries leading to tendonitis and sprains and causing heel and ankle pain. The ankle allows you to run, jump, walk, and turn by providing stability. When the ankle is injured, you need relief from the pain and to know what is available to help you heal from ankle tendonitis or a sprained ankle as quickly as possible.
The ankle is a hinge joint made up of three bones, the tibia (shin bone) and the fibula (small bone next to the shin bone) in the lower leg, and the talus bone (ankle bone). Ligaments are strong bands of fibrous tissue that bind bones together. The following four ligaments attach the ankle and shin bones:
- Deltoid ligament: inside of the ankle
- Anterior talofibular ligament: outside of the ankle, the first or only ligament injured in 97% of injuries
- Posterior talofibular ligament: outside of the ankle, usually only injured if the ankle is dislocated
- Calcaneofibular ligament: outside of the ankle
A hinge joint supports two movements, pulling the foot up towards the shin or dorsiflexion, and pointing the toes or plantar flexion. A cycle of dorsiflexion followed by plantar flexion allows the foot to strike the ground heel first, clear the surface of the ground, and propel the body forward for the next step.
Ankle sprains result when ligaments are stretched or torn when the foot twists, rolls, or turns beyond its normal range of movement. Risk factors for ankle sprains include the following:
- Walking or running on an uneven surface
- Participating in sports that require sudden changes in direction such as basketball, tennis, football, and soccer
- Not warming up properly before participating in sports
- Wearing improper shoes
Inversion and eversion injuries
When the ankle turns inward too far, inversion, pain and swelling are on the outside of the ankle. The most common type of ankle sprain is an inversion injury.
When the ankle turns outward, an eversion injury, the pain is on the inside of the ankle. An eversion injury can affect the tendons which support the arch of the foot leading to heel pain.
Symptoms of an ankle sprain include bruising, pain when bearing weight, restricted range of motion, ankle instability, and swelling. Ankle sprains are graded in the following way:
- Grade 1: The ligaments are stretched but not torn. Symptoms include mild pain and tenderness with some swelling and stiffness.
- Grade 2: There is partial tearing of the ligaments. Symptoms include significant swelling and bruising, pain with walking, and inability to move the ankle. The ankle joint may feel unstable.
- Grade 3: Complete tearing of the ligaments. Symptoms include severe swelling and pain, instability of the joint, and difficulty bearing weight.
Treating and healing pain from an ankle sprain
According to the American Academy of Orthopedic Surgeons, almost all ankle sprains can be treated without surgery. There are three phases of treatment for ankle sprains.
Phase 1: First Aid for healing an ankle sprain
To decrease the swelling and pain from an ankle sprain start with PRICE:
- Protection: Protect the injured ankle with a bandage or splint.
- Rest: Rest the ankle as much as possible to keep from stressing the injured ligament. Consider using crutches to keep weight off the ankle if you need to move around.
- Ice: Apply ice for 15-20 minutes at a time, two to three times per day, for the first 2-3 days. Wrap the ice in a cloth and remove the ice if the skin becomes numb.
- Compression: Use an elastic wrap to apply compression to the ankle for the first 24-36 hours after the injury. Wrap the ankle snugly, but not tightly, to limit the amount of ankle swelling.
- Elevation: Elevate the ankle above the level of your heart several times a day for the first 2-3 days. Elevation decreases bruising and swelling.
Phase 2: Treatment options to speed up healing and restore range of motion
- Non-steroidal anti-inflammatory medications (NSAIDs): Ibuprofen, naproxen, or topical NSAIDs decrease signs of inflammation, such as pain and swelling.
- Braces or air casts may be prescribed to protect and to stabilize the joint.
- BPC-157: BPC -157 is derived from a peptide found in human digestive juice. Animal studies have shown that body protective compound (BPC) can speed-up healing from soft-tissue injuries. BPC-157 is only available by prescription as it is labeled as a research medication. A telemedicine consultation with an Invigor Medicine health care provider can help you determine if BPC-157 is right for you.
- Physical therapy: Gentle exercise can increase blood flow to the injury, speed up healing, and reduce ankle pain. Exercises can improve the flexibility and strength of the ankle and increase the range of motion.
- Walking can help build strength and prevent stiffness.
- Agility exercises such as tracing the letters of the alphabet with your toes and walking and then running in a progressively smaller figure eight configuration can build strength, improve balance, and build endurance.
- Stretching exercises to increase the range of motion gradually and decrease the risk of heel pain after an ankle sprain.
Phase 3: Restoring strength and minimizing heel and ankle pain
Gradually return to activities that do not require turning or twisting movements. Warm-up before exercise to prevent stiffness, which may lead to chronic ankle sprains or heel pain. When in doubt, call your health care provider to ensure your injury is properly diagnosed and treated.
Ankle Tendonitis: Overuse injury
Unlike a sprained ankle, an acute injury, ankle tendonitis is an overuse injury. It may take more time to heal ankle tendonitis than an ankle sprain. Tendons connect muscles to bones. Two tendons run down the back of the ankle and insert on either side of the foot. These tendons support and stabilize the ankle joint.
Risk factors for ankle tendon
Activities that result in repetitive ankle motions can cause inflammation, pain, and swelling of the ankle tendons. Ankle tendonitis is more common in the following:
- Sports: gymnastics, dancing, basketball, football, and long-distance running
- Foot mechanics: high arches, heels that turn inwards, weak calf muscles
- Other: wearing the wrong type of shoes or after an acute injury such as an ankle sprain
Treatment for the pain from ankle tendonitis
Steps to treat and heal ankle tendonitis largely mirror the treatment for a sprained ankle. Consider the following treatment steps:
- PRICE: Use pressure, rest, ice, compression, and elevation to minimize swelling and decrease pain.
- Physical therapy: A physical therapist may use ice heat, ultrasound, and soft-tissue massage to decrease pain and increase blood flow to help heal ankle tendonitis.
- Exercise: Gradual range of motion exercises, strengthening exercises, and then more specific exercises to improve foot mechanics may be recommended.
- BPC-157: A body protective compound (BPC) such as BPC-157 has been shown in animal studies to accelerate healing from soft-tissue injuries. BPC-157 is only available by prescription. A telemedicine consultation with an Invigor Medicine health care provider can help you decide if BPC-157 is right for you.
Prevent further injuries
There are several steps you can take to prevent further injuries such as keeping your hips, knees, and ankles strong and flexible, wearing proper footwear, gradually increasing speed and intensity when training, and avoid running on uneven terrain.
While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.