Pain at the ankle is usually caused by local structures within or around the ankle, however in rare cases, pain may be referred from other sources (eg. lower back).
The most common mechanism of injury in cases of sudden onset ankle pain is a “rolled ankle”, whereby damage to the lateral ankle ligaments is quite common. Other structures may also be involved, such as cartilage, muscles , tendons or bones.
Gradual onset ankle pain often occurs as a result of activities that involve excessive walking or running loads, rapid changes in direction, inappropriate footwear and/or poor mechanics. In these cases overuse injuries of the tendons are common.
In older patients, another alternative cause of symptoms may be degenerative changes in the ankle, such as ankle arthritis.
There are numerous other causes of ankle pain, some of which present suddenly due to a specific incident, others which develop gradually over time.