What a squat asks of the ankle, and what no study has countedEmerging evidence
As you squat, your shin tips forward over your foot, so the ankle bends upwards (dorsiflexion, which we call ankle bend) while it carries your weight, and the deeper you go the more it bends. In 11 men squatting about three-quarters of their maximum, a squat to parallel used about 11 degrees less ankle bend than each lifter's maximum on the knee-to-wall (lunge) test. When the ankle runs out of bend, people squat less deep, lean forward more or lift their heels; dancers with a pinch at the front of the ankle lift the heel to keep going.
No study counts ankle pain caused by squatting: a search of the research found no study of people whose ankles hurt in squats. In lifting sports the ankle isn't one of the common injury sites. Reviews of weightlifting and powerlifting (9 studies) and of the weight-training sports (20 studies) name the spine, shoulder, knee, elbow and wrist; in 104 Swedish powerlifters the ankle wasn't among the regions named; and in 386 CrossFit athletes the ankle was 2 of 84 injuries, none of them from squats, deadlifts or presses.
So the map on this page is built from what each condition is known to do, squat lab studies in people without pain, and health-service pages. Pain usually comes when something at the ankle is pinched or loaded more than it can take, often after an old sprain or a jump in training; that is our reading, not a counted fact.
Sources 1, 2, 3, 4, 5, 6, 7, 8
The front of the ankle: "it pinches at the bottom of the squat"Emerging evidence
In anterior ankle impingement, something at the front of the joint is pinched as the shin comes forward at the end of ankle bend. Bone spurs are usually on the inner front; inflamed joint lining or scar tissue is usually on the outer front, often after sprains; and many people have both. Reviews list deep squatting among the triggers, and in ankles without symptoms, tissue at the front was squeezed beyond about 15 degrees of bend.
How common it is in the general population isn't known. In 6,754 professional footballers, ankle impingement caused 0.4% of the injuries that cost training or matches, 38% of them at the front. Front-of-ankle cases more often came on gradually (69% against 47%), kept players out longer (a median of 10 days against 6) and came back more often (31% against 9%) than impingement at the back.
A pinch at the front isn't proof of a bony block: soft tissue pinches too, and spurs are common in ankles that don't hurt, so the examination decides whether a spur matters. Practically, the depth just short of the pinch is your working depth for now.
Sources 9, 10, 4, 11
"It started after an old sprain": stiffness, giving way and what lies alongsideEmerging evidence
After a sprain, ankle bend usually comes back within weeks: in 22 people doing home exercises, it was back to normal within 4 weeks. But in 16 people with repeated sprains, 34% still bent less when standing and 71% had a talus (the ankle bone the shin sits on) that didn't glide back fully. Up to 40% of people develop an ankle that keeps giving way (chronic ankle instability) after a first sprain.
Other problems often travel with an unstable ankle. In 61 people having surgery for one, 77% had inflamed peroneal tendons (the tendons behind the outer ankle bone), 67% scar tissue at the front outer corner and 23% a damaged patch of cartilage on the talus. In 171 athletes scanned after an ankle ligament injury, 14% had cartilage or bone damage, mostly cartilage only, which X-rays often miss.
Sources 12, 13, 14, 15, 16
The back and sides of the ankle: the Achilles and the tendonsEmerging evidence
Deep ankle bend squeezes the Achilles against the heel bone where it attaches. Pain within about 2 cm of the heel bone is insertional Achilles pain (20% to 25% of Achilles cases); higher up is the middle of the tendon. Calf work starts on the flat floor for insertional pain.
On the inside, the tibialis posterior tendon holds up the arch, and pain there often comes with the arch dropping and the foot rolling in at the bottom of the squat; an NHS booklet for this tendon uses small squats with the arch held as an exercise. On the outside, the peroneal tendons are "under-appreciated" as a cause and often go with an unstable ankle, and pain in the soft hollow below the outer ankle bone (sinus tarsi syndrome) is a catch-all label for several causes rather than one condition.
Sources 17, 18, 19, 20, 21
Deep in the joint: cartilage damage and arthritisEmerging evidence
Deep pain with swelling after activity, catching or locking weeks after a sprain can be a damaged patch of cartilage on the talus, which needs checking. Years after an injury, a deep, stiff ache with grinding is more often arthritis: in 390 people with advanced ankle arthritis, 78% had an injury behind it.
The National Institute for Health and Care Excellence (NICE) diagnoses osteoarthritis from the symptoms in people 45 or over, without routine scans, and offers exercise to everyone with it. Arthritis UK says foot and ankle symptoms "probably won't get worse, and they may even improve".
Sources 16, 22, 23, 24
"My heels lift", clicks and popsEmerging evidence
Heels lifting usually means the ankle has run out of bend at that depth. It isn't dangerous in itself: we found no study linking heels rising with ankle injury. Our squat technique page uses flat heels as a depth marker for learners, and small plates under the heels, lifting shoes, a slightly wider stance or a goblet squat are the usual fixes.
Painless clicking is common. Clicking with pain on the outside can be the peroneal tendons slipping; catching or locking deep in the joint needs checking; and a pop at the back of the ankle with no pain or weakness is usually harmless, but a snap with sudden weakness is the Achilles rupture warning sign (our reading).
Sources 4, 19, 16
Rare but serious: a broken bone, a torn tendon, a hot joint or a clotEmerging evidence
Gradual pain in squats is rarely any of these, but they are the reasons to read the warning signs first. After a twist or fall, the NHS sends a crack, a changed shape or severe pain to A&E, and an ankle you can't put weight on to NHS 111 or an urgent treatment centre: you can have a broken bone and still walk. A snap at the back of the heel, then being unable to push off, can be a torn Achilles.
Without an injury, a sudden hot, swollen, red ankle, especially with a high temperature, can be gout or a joint infection, which the NHS says needs checking straight away. A throbbing, swollen calf, especially after an ankle injury or time in a cast or boot, can be a blood clot (deep vein thrombosis, DVT). Pain at the top of the foot or the heel rather than the ankle has its own causes, which our heel and foot guides map.
Sources 25, 26, 27, 28, 29
What a scan shows, and what it doesn'tStrong evidence
After a twist or fall, the Ottawa ankle rules decide on an X-ray: being unable to take four steps, or tenderness at the back edge or tip of either ankle bone. Across 27 studies of 15,581 people they missed almost no fractures and cut X-rays by 30% to 40%. They are for an injury, not for pain that builds up in squats.
For a pinch that won't settle, the diagnosis rests on the story and the examination. An X-ray with an angled (oblique) view shows spurs (85% of shin-bone and 73% of talus spurs, against 40% and 32% on a side view alone) and is used when surgery is being planned. Magnetic resonance imaging (MRI) is unreliable for soft-tissue impingement but shows cartilage damage. Typical Achilles pain and arthritis need no scan.
Read reports with care: X-ray changes showed in 52% to 59% of 88 professional footballers' ankles, spurs in 59% of dancers without symptoms, and MRI wear changes in 86.5% of 37 elite footballers without symptoms.
Sources 30, 31, 9, 32, 4, 33, 18, 23, 16
How it usually goesEmerging evidence
No study follows ankle pain in squats, and nobody has followed front-of-ankle impingement without treatment; in professional football, front-of-ankle cases kept players out for a median of 10 days. After a sprain, pain eases fast in the first 2 weeks, but across 31 studies 5% to 33% still had some pain at a year. NHS trusts say a sprain takes 6 to 12 weeks, with some swelling and pain for 3 to 6 months.
Achilles pain takes "several months or more", 80% of 34 people had fully recovered at 5 years, and 23% to 37% have symptoms for up to 10 years. NHS inform says most new ankle problems begin to settle within 6 weeks. No one can promise a date.
Sources 10, 11, 34, 26, 35, 36, 37, 38, 18, 39
