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Ankle Pain

Below are the most common causes of ankle pain we see and successfully treat.


What is it?

The tibialis posterior tendon, starts in the back of the calf and courses down the inside of the ankle and attaches to most of the bones within the foot.

This tendons job is to slow down and limit the amount the foot can roll to the inside when we walk.

In this condition, the tendon can become overloaded for a variety of reasons.  This allows the foot to roll in a bit further than it should,  which in turn puts even more load through the tendon.   This is a vicious cycle which results in further  flattening of the foot and further excess loading of the tendon and this can continue until the arch completely collapses and you end up weightbearing on the middle of your foot.


It is thought it may be a case of chicken and egg.  A flat foot will put more stress through the tendon.  A stressed tendon will result in a flat foot.  It may be you have always had a mild flat foot and overtime the tendon has become progressively weaker.  Often, we see patients who have increased their activity levels, or worn unsupportive shoes for a period of time.  Good examples of this will be patients that have worn flip flops while on holiday and done a lot of walking, or patients that have taken up a new sport or hobby.

Signs and Symptoms:

Pain can be mild to severe primarily around the inside of the ankle, which gets progressively worse while walking.  It can keep you awake at night and stop you from doing the activities you love.

Because it leads to a progressively worsening flat foot, this can lead to other painful conditions in the foot, including mid foot arthritis and sinus tarsi syndrome and lateral ankle pain.


There are several different classification systems of adult acquired flat foot as we know it is a progressive condition.  If left untreated, overtime it can lead to complete collapse of the foot and ankle which may then require foot surgery to correct.  Foot surgery for adult acquired flat foot deformity is not an easy option.  However, most patients get pain in the early stages and seek help, before their foot collapses.
You are much more likely to get a good outcome from treatment, with no long term damage if we can treat you in the early stages.

Treatment Options:

This very much depends upon the stage of the deformity but will include;

  • Footwear advice
  • Taping and Strapping
  • Temporary Wedging/Insoles
  • A walking boot for temporary pain relief
  • Fully bespoke casted foot orthoses
  • Bracing
  • Physiotherapy
  • Referral for a surgical opinion

Lateral Ankle Sprains:

The most common one would be a lateral ankle sprain, but as this is caused by an acute injury of turning an ankle, we will not normally see these until they have been present for some months without healing.

Foot and ankle function, footwear and insufficient rehab can all cause persistent pain from an ankle sprain many months after the incident, or result in recurring ankle sprains.  You may have heard people say they have weak ankles which causes them to regularly sprain an ankle.  Generally, this is more to do with their foot and ankle function and there are several options available to alter the foot and ankle function, relieve their pain and reduce the chances of further injury.

Sinus Tarsi Syndrome:

This is a common cause of pain on the outside of the ankle, just in front of the ankle bone.

The sinus tarsi is a small tunnel formed by two bones, the calcaneus (the heel bone) and the talus (that forms the ankle joint with your tibia).

Typically pain can start after an ankle sprain and persist after the ankle sprain has healed.  Alternatively this can be caused by a flat foot due to tibialis posterior tendon dysfunction.  As the foot becomes progressively flat, the talus and the calcaneus change position and spend a greater time in contact with each other than they should resulting in pain.

Treatment options are based around changing foot and ankle mechanics to offload the area.

  • Footwear advice
  • Taping and Strapping
  • Temporary Wedging/Insoles
  • Fully bespoke casted foot orthoses

Ankle Arthritis:

The ankle joint is made of the bones of the talus and the bottom end of the tibia.  It's a complex joint and is frequently a cause of pain.

The most common condition causing pain in the actual ankle joint itself is osteoarthritis.

It is usually caused by acute trauma to the ankle, which may have occurred many years ago and slowly over time arthritis develops.  Alternatively an untreated or severe adult acquired flat foot can lead to arthritis in the ankle joint.

Pain can persist, despite physiotherapy, injections and surgery.  Altering foot mechanics through using customised foot orthoses or bracing can provide a reduction in pain, improve function and prevent the need for surgery.