Let’s face it—ankle pain can be a real disruptor. Whether you’re chasing your kids around, commuting to Boston, or hiking one of New Hampshire’s 4,000-foot peaks, your ankles are doing a lot of heavy lifting. And when they start to hurt, everything slows down.

The good news? You’re not alone. Even better? Most causes of ankle pain are treatable—especially if you catch them early.

Here at Foot & Ankle Associates of Southern NH, I’ve treated thousands of patients with ankle pain, from soccer players to weekend skiers. And in nearly every case, it comes down to one of these 7 culprits.

Let’s dive in.

1. Ankle Sprains: The Classic Culprit

You twist your ankle stepping off a curb—or maybe during that pickup hockey game—and boom: swelling, pain, and maybe a little bruising.

Why it happens: Ligaments get stretched or torn. It’s the most common ankle injury, especially among active adults and teens.

What to do: RICE (Rest, Ice, Compression, Elevation) is a solid start. But if swelling persists or you can’t bear weight, come in for an exam. Ignoring a bad sprain can lead to chronic instability.

2. Achilles Tendonitis: Pain in the Back (of the Ankle)

That nagging pain above your heel? It could be Achilles tendonitis, often caused by overuse or improper footwear.

Common in: Runners, weekend warriors, and anyone suddenly ramping up activity.

Fix it fast: We’ll likely recommend stretching, physical therapy, custom orthotics—and yes, sometimes rest. Left untreated, this can become a rupture, which means surgery.

3. Arthritis: More Than Just “Getting Older”

Osteoarthritis can settle into the ankle, especially after a past injury. You may feel stiffness, swelling, or pain that gets worse throughout the day.

Don't ignore it. Ankle arthritis is manageable with the right care, including lifestyle changes, bracing, and newer regenerative treatments.

4. Flat Feet or High Arches: Hidden Pain Triggers

Your foot structure plays a huge role in how your ankle feels.

• Flat feet can cause inward rolling (overpronation), stressing the ankle.

• High arches reduce shock absorption, overloading joints.

The fix: A gait analysis and custom orthotics can work wonders here.

5. Posterior Tibial Tendon Dysfunction (PTTD): The Silent Arch Killer

Often misdiagnosed, PTTD weakens the tendon that supports your arch. That leads to flatfoot—and, you guessed it—ankle pain.

Watch for: Pain along the inside of the ankle, especially when walking or standing for long periods.

Treatment: Bracing, orthotics, and sometimes surgery if it’s progressed.

6. Fractures (Yes, Even Tiny Ones)

Stress fractures in the ankle can occur without one dramatic injury. Think: repetitive stress, especially in athletes or people with bone density issues.

Symptoms: Pain that gets worse with activity, mild swelling, tenderness.

Diagnosis: We’ll take X-rays or imaging to confirm and get you on the fastest track to healing.

7. Chronic Ankle Instability: The Recurring Nightmare

Have you sprained the same ankle more than once? Does it feel like it “gives out” randomly?

You might have chronic ankle instability, where ligaments are permanently weakened.

Solution: Physical therapy, bracing, and in some cases, a surgical fix to tighten things up. The earlier we intervene, the better.

What to Do Next

If you're reading this, you’re probably tired of wondering why your ankle hurts—or frustrated that it keeps coming back.

Here’s what I recommend:

1. Don’t ignore ankle pain. Small problems become big ones fast.

2. Get evaluated by a specialist. At our clinic, we use diagnostic imaging and biomechanical analysis to get answers.

3. Create a plan. Whether it's physical therapy, custom orthotics, or surgery, we tailor a plan to your lifestyle and goals.

🎯 Ready to Get Back on Your Feet?

At Foot & Ankle Associates of Southern NH, we’re here to help you move pain-free—whether that means hiking Mount Monadnock or just walking the dog without limping.

Schedule your appointment today and take the first step toward stronger, healthier ankles.