Pain guide · Ankle pain
Ankle pain is common in later life, affecting about 1 in 9 people over 50, but it isn't just part of getting older. The usual causes are arthritis, which mostly follows an old sprain or break, the tendon that holds up the arch along the inner ankle, and gout, while swollen ankles have causes of their own, from sitting still and some blood pressure tablets to the veins and the heart. Strength and balance exercise, good shoes and a few changes at home help at any age, and they also help you stay steady on your feet.
This guide starts with the warning signs: one swollen, painful leg needs help the same day, swollen ankles with breathlessness need an urgent general practitioner (GP) appointment or the National Health Service's 111 line (NHS 111), and chest pain or severe breathlessness needs 999. A twist or fall that leaves you unable to take four steps needs checking, and a hot, swollen ankle needs help the same day. Then it sorts the causes by where it hurts, explains which swelling matters, covers shoes, sticks, stairs and falls, says when to see a GP, and gives a three-stage plan with 3D demos.
Exercise is for pain that has been checked or is clearly mild and settling.
Location narrows the likely causes; it does not diagnose.
Usually ankle arthritis, which mostly follows an old injury rather than age. Our ankle arthritis guide covers it.
Read: Ankle arthritis and stiff ankles →Behind and below the inner ankle bone and along the arch, worse walking and by evening, with the arch dropping on one sideOften the tibialis posterior tendon, most common in women from middle age and often missed. Being unable to rise onto tiptoe on that foot is the clue. Our tibialis posterior guide covers it.
Read: Posterior tibial tendon dysfunction →A flat foot you didn't have before, or on one side onlySee a GP, as the warning signs say. Our flat feet guide explains which flat feet matter.
Read: Flat feet →Burning or tingling into the sole from the inner anklePossibly a squeezed nerve behind the inner ankle bone. Our tarsal tunnel guide covers it.
Read: Tarsal tunnel syndrome →The cord at the back of the ankle, stiff in the morningUsually Achilles tendinopathy. A sudden snap there needs checking the same day. Our Achilles guide covers it.
Read: Achilles tendinopathy →The outer ankle after a twist, or an ankle that keeps giving wayUsually a sprain, but a break is possible even if you can walk, so check the X-ray points in the warning signs. Our outer ankle pain guide maps the causes.
Read: Outer ankle pain →Usually fluid, from sitting or standing still, warm weather, the veins or some medicines such as amlodipine. See a GP if it doesn't settle in a few days, or you have a heart, kidney or vein condition.
Possibly heart failure, which treatment helps: get an urgent GP appointment or NHS 111, as the warning signs say.
It could be a blood clot (DVT): get help the same day, as the warning signs say. Our calf pain guide covers it.
Read: Calf pain →Gout or a crystal arthritis, which become more common with age, but it could be a joint infection: get help the same day, as the warning signs say.
Possibly peripheral arterial disease (narrowed leg arteries): see a GP. Our calf pain when walking guide covers it.
Read: Calf pain when walking →Possibly an infection or a Charcot foot: contact your diabetes foot team or GP within 1 working day, as the warning signs say.
Our ankle pain at night guide sorts the causes.
Read: Ankle pain at night →Ankle pain when you walkOur ankle pain when walking guide covers shoes, supports and a plan.
Read: Ankle pain when walking →Recovering from a broken ankleOur broken ankle guide covers the boot or cast and the exercises; your fracture clinic's plan comes first.
Read: Broken ankle →The foot rather than the ankle: the heel, big toe, midfoot, toes or numb feetOur foot pain in older adults guide covers the foot, footcare, shoes and falls.
Read: Foot pain in older adults →In one UK study of 5,109 people aged 50 and over in North Staffordshire, 11.7% had ankle pain in the past month: 14.1% of women and 9.2% of men. In that study it was no more common in older age groups (12.2% at 50 to 64, 11.2% at 65 to 74 and 11.1% at 75 and over), though the age groups' ranges overlapped and fewer women over 75 took part. Across population studies, about 15% of people aged 45 and over had frequent ankle pain.
Only 3.4% of people over 50 had painful ankle arthritis on X-ray in the UK study, against 16.7% for the foot and 12.0% for the knee. In specialist centres, 70% to 78% of severe ankle arthritis followed an injury, most often an old ankle fracture. "Joint injuries can also make you more likely to get osteoarthritis, and this is particularly the case with ankle injuries", Arthritis UK says.
The National Institute for Health and Care Excellence (NICE) diagnoses osteoarthritis without an X-ray from 45 when the pain comes with activity and morning stiffness lasts 30 minutes or less. Longer stiffness, or several swollen joints, points to an inflammatory arthritis, which needs a GP.
Tibialis posterior tendon problems affected 3.3% of women over 40 at one English practice, and none had been diagnosed. A review lists flat feet, high blood pressure, diabetes and a steroid injection near the tendon as risks, and an NHS Lothian leaflet adds past ankle injuries, a sudden rise in activity, less supportive footwear and a higher body weight. Most people are first told they have a sprain or arthritis.
The signs are pain and swelling behind and below the inner ankle bone, worse with walking and by evening, the arch flattening, and being unable to rise onto tiptoe on that foot. The NHS asks you to see a GP for flat feet that are new, painful or on one side only.
"Swelling in the ankles, feet or legs often goes away on its own", the NHS says. The usual causes are sitting or standing still for long, salty food, weight, some medicines (blood pressure tablets, steroids, antidepressants, hormone treatments), varicose veins and thyroid problems; less often the kidneys, liver or heart, a clot or an infection. One US review calls weak leg veins the commonest cause in older adults.
Amlodipine and similar blood pressure tablets caused ankle swelling in 10.7% of people across 106 trials (12.3% with the amlodipine group), against 3.2% on placebo or other tablets, more often at higher doses. Lymphoedema is less common: soft swelling that may come and go and get worse during the day.
Heart failure causes swollen ankles with breathlessness on everyday activity or lying down, tiredness and sudden weight gain. About 1 million people in the UK have it, and the average age at diagnosis is 76. The NHS stresses that it "does not mean your heart has stopped working", and treatment "can help manage symptoms and keep heart failure stable for many years".
A clot in a leg vein (deep vein thrombosis, DVT) usually causes throbbing pain and swelling in one leg, with red or darker skin. Being over 60, heart failure, varicose veins, surgery or a hospital stay, a long journey and time in a cast make it more likely.
In Denmark, broken ankles were more common in women (203 against 154 per 100,000 a year), and rising most in women over 50. In one Turkish emergency department study of 160 people aged 65 and over with an ankle injury, 37.5% had a break, against about 10% to 12% of adults in the original Canadian studies, so a twist in later life deserves a check.
Clinicians use the Ottawa ankle rules to decide who needs an X-ray: tenderness at the back edge or tip of either ankle bone, or being unable to take four steps. Across 27 studies they missed almost no breaks, they worked in that study of people aged 65 and over (98% of breaks picked up), and NICE uses them for everyone over 5. Whether ankle fractures in later life are linked with thin bones is mixed: one study found higher weight, not osteoporosis, raised the odds.
Gout is still more common in older men than women, but the gap narrows with age (2.5 times at over 90), and water tablets, kidney problems and the menopause raise the risk. NICE names the ankle among the joints it can affect. Calcium pyrophosphate crystal arthritis (once called pseudogout) is linked with ageing and osteoarthritis, and fluid from the joint confirms it. A joint infection is less common but urgent; a high temperature is usual, "although not everyone has one", the NHS says.
About 20% of people over 60 have some narrowing of the leg arteries (peripheral arterial disease), often without symptoms; smoking is the biggest risk. The ache usually comes in the calf, thigh or buttock on walking, and eases with rest. "Many people mistakenly think this is just part of growing older", the NHS says.
With diabetes, NICE asks clinicians to suspect a Charcot foot with redness, warmth or swelling "even when deformity is not present or pain is not reported", and warns that a broken foot or ankle can progress to it.
Ankle arthritis needs no routine X-ray, NICE says. An X-ray matters after a twist or fall when the Ottawa points apply, and before surgery. The tibialis posterior tendon is diagnosed by examination ("Scans are not usually needed").
Swelling in one leg needs an ultrasound scan within 24 hours if a clot is suspected; breathlessness with swollen ankles needs a blood test (NT-proBNP) and, if it is raised, a heart scan (echocardiogram); leg ache on walking needs the ankle-brachial pressure index; a hot, swollen joint may need a urate test and fluid from the joint; and a suspected Charcot foot needs a weight-bearing X-ray, then magnetic resonance imaging (MRI) if that is normal.
"In many cases, new pain or a flare-up of long-standing ankle problems should begin to settle within 6 weeks", NHS inform says. With ankle arthritis, "your symptoms probably won't get worse, and they may even improve", Arthritis UK says, though no study has put numbers on it. The tibialis posterior tendon is easier to treat early. A broken ankle "usually takes 6 to 8 weeks to heal, but it can take longer", and an untreated gout attack "usually lasts 1 to 2 weeks". No one can promise a timescale.
NICE offers therapeutic exercise to everyone with osteoarthritis and warns that "joint pain may increase when they start", but that regular exercise "will be beneficial for their joints". The evidence is borrowed from other joints, as ankle trials are thin. Strength training works in later life: across 121 trials of older adults, it gave large gains in strength and in getting out of a chair, with serious side effects rare.
Across 108 trials of people living at home (average age 76, 77% women), exercise cut falls by 23% and the number of people falling by 15% (high certainty). Foot and ankle exercise programmes improved balance and ankle movement a little in 8 trials, but haven't been shown to cut falls on their own. NICE's 2025 falls guideline offers a falls assessment, including footwear and foot problems, after a fall that needed treatment, 2 or more falls, or being unable to get up.
Stiff ankles, weak toes, poor feeling under the foot and foot pain predicted falls in 176 older people. A podiatry package of insoles, shoe advice and foot and ankle exercises, done for 30 minutes 3 times a week, cut falls by 36% in 305 people aged 65 to 93, but a larger UK trial of 1,010 people found a smaller, uncertain effect.
In a trial of 36 adults, insoles with slow-lowering band exercises improved function most; in another of 39, adding home strengthening was "minimally effective". The trials, 93 people in all, were mostly women in their 50s, so the evidence is borrowed for older readers. NHS Lothian advises insoles, "supportive footwear, such as a running type trainer or boot" and exercise, starting early. A steroid injection near the tendon is advised against.
NICE prefers a gel anti-inflammatory for joints other than the knee, doesn't routinely offer paracetamol or weak opioids, allows a steroid injection for "short-term relief (2 to 10 weeks)", and offers braces only when the joint is unstable and exercise alone isn't enough. Arthritis UK suggests "A light but stiff walking boot" or a rocker added to your shoes, untested in trials.
When other treatments haven't worked, ankle replacement and fusion gave similar walking and standing scores at a year in a UK trial of 303 people aged 50 to 85, with more wound problems after replacement (13.4% against 5.7%).
In 620 adults over 60 (average age 71) with an unstable ankle fracture, a closely moulded cast gave the same ankle function as surgery at 6 months, with fewer infections and wound problems (1% against 10%) but more bones healing out of line (15% against 3%); 19% of the cast group went on to have surgery. Your fracture team decides which suits you.
The NHS advises raising the legs, gentle walking, wide comfortable shoes and not sitting or standing still for long. Amlodipine-type swelling was less common at lower doses in the trials, so a GP or pharmacist can review the tablet; don't stop it on your own. Compression stockings help some vein problems, but NICE checks for narrowed arteries before compression.
The NHS suggests wide, comfortable shoes with a low heel and soft sole, and shoes or slippers that "fit well, do not slip off and have a good grip"; Age UK says no bare feet, socks or tights at home. NICE suggests walking aids such as sticks for osteoarthritis, and NHS inform suggests a stick on the opposite side if you limp. No trial has tested shoes for ankle pain in older people. Age UK suggests thin soles for balance and Arthritis UK cushioned soles for arthritis; a firm, non-slip sole that isn't too thick is a sensible middle (our suggestion).
During the exercises, NHS inform rates 0 to 3 out of 10 as minimal pain, 4 to 5 as acceptable and 6 to 10 as too much: "Aim to keep your pain within a rating of 0 to 5", and your pain should be "no worse the morning after you've exercised". If it goes above that, do fewer, slow down or rest longer between moves, and stop any exercise that makes your symptoms worse or causes new pain.
To move up a step, borrow the podiatry falls trial's stricter rule: add repetitions or resistance only with "no pain during the movement and no muscle soreness the next day" (as our foot pain in older adults guide does). The Otago booklet adds that slight muscle soreness the next day is normal, and to stop for chest pain, dizziness or severe shortness of breath. With arthritis, NICE says pain may rise a little at first.
One spot on a bone should stay pain-free; burning, tingling or numbness means stop that movement; and with numb feet, check your skin afterwards. Swelling in one leg, breathlessness, a hot, swollen ankle or a cold, pale foot aren't pain-rule questions: they are warning signs.
Start at the first stage. Each move opens a full guide with a 3D demo.
About the first 2 weeks, daily: gentle range and calf work sitting, short walks, and the swelling steps below. No trial has tested a plan for ankle pain in older adults; the doses come from NHS inform, the NHS exercises for older people, the Otago booklet and the move pages, as named. With a diagnosed condition (a broken ankle, a tendon problem, gout), its guide's plan comes first.
3D demoAnkle circlesBeginner · No equipment10 slow circles each way with each foot, sitting · The move page's dose (an editorial starting point). The NHS sitting ankle stretch, pointing the toes away then back, 2 sets of 5 with each foot, fits in between
3D demoSeated bent-knee calf raise (soleus raise)Beginner · A bench or box2 to 3 at a time, building to sets of 8, up to 2 sets of 15, 2 to 3 times a day · NHS inform's seated heel raise and its pacing
Harder: Slow calf raise
3D demoSeated calf stretch with a towelBeginner · Other / check instructionsHold 20 to 30 s, 2 to 3 sets, 2 to 3 times a day · NHS inform's stretch dose
3D demoKnee-to-wall ankle rockBeginner · A wall10 slow rocks per side, daily, holding a counter, in a smaller range if it pinches at the front · The move page's dose
3D demoTreadmill walkingBeginner · Cardio machine10 minutes at a comfortable pace most days, outdoors or indoors, in fastened shoes · An editorial start, building towards the NHS's 150 minutes a week for older adults. Cycling is a gentler option if walking flares arthritis (editorial)
Harder: Treadmill jogging
Move on when: The moves feel comfortable within the pain rule, and the ankle is no worse the next morning (NHS inform's check).
About weeks 2 to 8: strength 2 or 3 times a week and balance at least twice a week, as the NHS asks. Do standing moves next to a kitchen counter, a sturdy chair or a wall.
3D demoSlow calf raiseBeginner · A wallLift for a slow count of 3 and lower for a count of 5, 10 times, building to 20, holding support · The Otago booklet's calf raise; the NHS strength version starts at 5. Stop short of full tiptoe with ball-of-foot or big toe pain, as the move page says
Easier: Seated bent-knee calf raise (soleus raise) · Harder: Standing dumbbell calf raise
3D demoTibialis raiseBeginner · No equipmentLift your toes and hold for a slow count of 5, 5 times each foot · The Otago booklet's toe raise, done sitting in the booklet; standing near support is the move page's version (editorial)
Harder: Single-leg tibialis raise
3D demoBand ankle inversionBeginner · A band + A bench or boxFor pain along the inner ankle and arch: 3 sets of 15, twice a day, with a slow return, starting with a lighter band · The move page's dose, from a tibialis posterior trial in people in their 50s, which worked up to a band you can only just manage; starting lighter is editorial, as the move page says
3D demoBand ankle eversionBeginner · A band + A bench or box2 to 3 sets of 10 · Editorial, as in our ankle arthritis guide
Easier: Isometric ankle eversion against a wall · Harder: Single-leg stand
3D demoSide-stepping (sideways walking)Beginner · A wall10 steps each way, next to a counter · The move page's dose, from the NHS balance exercises
Harder: Lateral band walk
3D demoTandem stance and heel-to-toe walkBeginner · A wallAt least 5 heel-to-toe steps beside a wall, moving away from the wall as you improve · The NHS balance exercises' dose. With numb feet, keep a hand on the wall, as the move page says
Easier: Semi-tandem stance · Harder: Single-leg stand
Move on when: Ten slow calf raises and 5 heel-to-toe steps by a wall are steady, with no pain during the moves and no soreness the next day (the podiatry falls trial's rule for moving up).
From about week 8, 2 or 3 sessions a week, then keep going. Longer walks, shopping, gardening, bowls, dancing and holidays come back one at a time, a little more each week (our suggestion), in fastened shoes. A local falls service, strength and balance class or walking group helps many people keep it up.
3D demoSit to stand from a chairBeginner · A bench or box5 slow repetitions from a firm chair, building to 10 · The NHS strength exercises ("The slower the repetitions, the better") and the Otago booklet (up to 10)
Easier: Sit to stand, pushing on the thighs · Harder: Bodyweight squat
3D demoSlow calf raiseBeginner · A wallFrom 20 on both feet, add a few each week, then a few on one leg near support · The Otago start; the build is editorial
Easier: Seated bent-knee calf raise (soleus raise) · Harder: Standing dumbbell calf raise
3D demoSingle-leg standBeginner · A wallHold 5 to 10 s, 3 times each side, fingertips on a counter, building towards 30 s · The NHS balance exercises' start; the build is editorial. With dizziness or a recent fall, stay within reach of support with someone nearby, as the move page says
Easier: Tandem stance and heel-to-toe walk · Harder: Single-leg reach matrix
3D demoLow step-upBeginner · A stepUp to 5 steps with each leg on the bottom stair, holding the rail · The NHS balance exercises' dose
Harder: Step-up
3D demoGet up and down from the floorBeginner · No equipment5 to 8 slow cycles down and up · The move page's dose (editorial). Have someone with you and a sturdy chair close by the first few times, as the move page says
Easier: Sit to stand from a chair · Harder: Bodyweight get-up
3D demoTreadmill walkingBeginner · Cardio machineBuild towards 150 minutes a week of moderate walking, with slopes and kerbs · The NHS activity guideline for older adults; how it builds is editorial
Harder: Treadmill jogging
Move on when: Our suggestion: a normal week of walking and getting out passes the pain rule. Then keep the strength and balance work going at least twice a week, as the NHS asks for older adults.
Our 3D figure can't show these. They come from the NHS and NICE, except where marked as our suggestion.
These come from the NHS, NHS inform, Arthritis UK, Age UK and an NHS Lothian leaflet.
These come from the NHS and NICE.
| Habit or position | Why it matters | Instead |
|---|---|---|
| Sitting for hours with your feet down | Swelling collects, and long spells of sitting still raise the risk of a clot, the NHS says. | Up and moving every hour, the legs raised on a stool, and the seated ankle moves.Try: Ankle circles |
| Putting one swollen, painful leg down to age | It can be a blood clot. | Same-day help: an urgent GP appointment or NHS 111. |
| Putting breathlessness with swollen ankles down to age | It can be heart failure, which treatment helps. | An urgent GP appointment or NHS 111. |
| Stopping a blood pressure tablet because of swollen ankles | The swelling is a known side effect, but stopping the tablet can do harm (our reasoning). | Ask your GP or pharmacist about a different dose or tablet. |
| Compression socks from the chemist with leg ache on walking | NICE checks for narrowed arteries before compression. | See a GP first; then stop-start walking if it's claudication.Try: Treadmill walking |
| Resting an arthritic ankle completely | NICE makes exercise a core treatment for osteoarthritis at any age. | The first stage's moves and short walks.Try: Knee-to-wall ankle rock |
| Forcing a stretch of a painful inner ankle | The tendon trials strengthened it rather than stretching it, and holding the ankle at the end of its range may squeeze it (our reasoning). | Band work in a comfortable range.Try: Band ankle inversion |
| Walking it off after a twist when you can't take four steps | Broken ankles are common in later life, especially in women, and you can have a break and still walk. | Get it checked the same day. |
| Slip-on or backless shoes and loose slippers | They give poor support and go with more falls. | Fastened shoes or slippers that grip. |
| Balance work with numb feet and nothing to hold | Numb feet and dizziness raise the risk of a fall. | Fingertips on a counter, as the move page says, or the heel-to-toe stance by a wall.Try: Tandem stance and heel-to-toe walk |
A 15-minute barefoot routine for stronger toes, arches, calves and ankles, finishing with balance. You need only a towel, a wall and a resistance band.
15 minBeginner11 movesA wall, Other / check instructionsA 40-minute strength and balance session for over-65s, built from the Otago home programme and NHS exercises, using a chair, a counter and a step.
40 minBeginner18 movesA bench or box, Something with weightA 20-minute seated workout for older adults who cannot stand for long: marching, leg and arm strength, posture, and sit-to-stands that lead back to standing.
20 minBeginner11 movesA bench or box, Something with weightBalance practice in 10 minutes: tandem stance, single-leg stands, marches, heel walks, tree pose and floor transfers.
10 minBeginner7 movesA wall, A bench or boxA 15-minute calf pump routine for varicose veins and heavy, swollen legs: ankle pumps, calf raises, a brisk walk, calf stretches and legs up to finish.
15 minBeginner10 movesA bench or box, A wallThe walk-rest-walk session for leg pain from narrowed arteries: walk until the pain is close to the most you can bear, rest until it goes, repeat to 30 minutes.
45 minBeginner8 movesA wall, Cardio machineNo: about 1 in 9 people over 50 have ankle pain, but most of it has a cause that can be helped, such as an old injury, a tendon, swelling or gout. Exercise, good shoes and a few changes at home help at any age.
Most often arthritis after an old sprain or break, the tibialis posterior tendon along the inner ankle, or gout. A sudden hot, swollen ankle needs the same day, because it can be an infection.
Swelling of both ankles that is worse by the evening is common, from sitting or standing still, warm weather, salt, weight, the veins or medicines, and it often settles. See a GP if it doesn't settle in a few days or you have a heart, kidney or vein condition. Get help the same day for one swollen leg or sudden, painful, red swelling, and call 999 if you're also short of breath or have chest pain.
After a twist it is usually the injury, but one swollen, throbbing leg with red or darker skin can be a blood clot and needs help the same day. Being over 60, recent surgery or a hospital stay, a long journey or heart failure make a clot more likely.
Yes: amlodipine and similar tablets caused ankle swelling in about 1 in 8 people taking them in trials, more often at higher doses. Don't stop them on your own; a GP or pharmacist can suggest a different dose or tablet.
Get it checked the same day if you couldn't take four steps afterwards, or pressing on the back edge or tip of either ankle bone hurts. Clinicians use these points to decide who needs an X-ray, and you can have a break and still walk.
Yes: the tibialis posterior tendon can weaken, so the arch drops on one side and rising onto tiptoe gets hard; it is most common in women from middle age. See a GP, physiotherapist or podiatrist early, as insoles, supportive shoes and exercises work best before the foot stiffens.
Yes, within the pain rule: NICE recommends exercise and general fitness for osteoarthritis at any age. A light, stiff walking boot or a rocker sole can ease walking, and cycling or swimming are gentler if walking flares it.
Wide, low-heeled shoes with a fastening and a non-slip sole, a supportive trainer or boot for an inner ankle tendon problem, and never bare feet or socks around the house. No trial has tested shoes for ankle pain in later life, so go by comfort and grip.
Yes: gout can affect the ankle and midfoot as well as the big toe, and it becomes more common with age, especially with kidney problems or water tablets. A hot, red, swollen ankle needs the same day, as it can also be an infection.
Foot and ankle exercises improve balance and ankle movement a little, and strength and balance programmes cut falls by about a quarter. Do them at least twice a week, near a counter, and ask about a falls service after a fall.
Only after a GP or nurse has checked your circulation, because narrowed arteries need ruling out first. Raising your legs and walking help in the meantime.
Exercise education, not a diagnosis or treatment plan. It is written from the guidelines and studies listed above; review by a clinician is pending. If your pain follows an injury, is severe, is getting worse, or comes with any warning sign listed on this page, get it assessed. Health disclaimer.
