Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.
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Medically Reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists, Michigan. Last updated April 2026.
Ankle Pain Without a Clear Injury
Most people associate ankle pain with a specific traumatic event — twisting an ankle during sport, rolling it on uneven ground, or fracturing it in a fall. But a substantial proportion of patients present with ankle pain that developed gradually, without any identifiable injury, leaving them confused about the cause and uncertain about treatment.
At Balance Foot & Ankle in Howell and Bloomfield Township, Michigan, we evaluate atraumatic ankle pain regularly and help patients identify the underlying cause driving their symptoms.
1. Peroneal Tendinopathy
The peroneal tendons run along the outer ankle, and peroneal tendinopathy produces a dull aching pain on the outer ankle that worsens with activity. Without a clear sprain history, this is often missed on initial evaluation. It develops from repetitive overuse — particularly in runners, dancers, and those who walk on uneven terrain. Ultrasound or MRI confirms the diagnosis. Treatment: activity modification, physical therapy, and custom orthotics.
2. Posterior Tibial Tendinopathy
The most common cause of inner ankle pain that develops without trauma is posterior tibial tendinopathy — progressive degeneration of the tendon that supports the arch. It presents with aching on the inner ankle extending toward the arch, often with progressive flattening of the foot. It is common in women over 40 and those with flat feet or obesity. Treatment: custom orthotics, physical therapy, and in advanced cases, surgical reconstruction.
3. Ankle Arthritis
Post-traumatic or inflammatory arthritis of the ankle joint produces progressive deep aching, morning stiffness, and reduced range of motion without a specific recent injury. There may be history of old ankle fractures or sprains from years prior. X-rays show joint space narrowing. Treatment ranges from orthotics and injections to ankle replacement or fusion in end-stage disease.
4. Os Trigonum Syndrome
An os trigonum — an accessory bone behind the talus, present in approximately 10% of the population — can cause posterior ankle pain with plantarflexion activities without prior trauma. It is often an incidental finding on X-ray but becomes symptomatic when compressed. Common in dancers and soccer players. Treatment: modification, injection, or surgical excision.
5. Tarsal Coalition
Tarsal coalition — an abnormal bony or fibrous bridge between two tarsal bones — can cause ankle and midfoot pain that presents in adolescence or early adulthood without a specific injury. Associated with rigid flat feet and restricted subtalar motion. Diagnosed with CT scan. Treatment ranges from orthotics to surgical resection or fusion.
6. Systemic Inflammatory Arthritis
Rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, reactive arthritis, and gout can all cause ankle pain that develops without trauma. Key distinguishing features include bilateral involvement, morning stiffness lasting more than an hour, systemic symptoms (fatigue, skin or eye changes), or serum markers of inflammation. Referral to rheumatology for systemic management complements local podiatric treatment.
7. Nerve Entrapment
Tarsal tunnel syndrome (posterior tibial nerve compression), sural nerve entrapment, and superficial peroneal nerve entrapment all cause ankle pain — often described as burning, tingling, or electric — without a traumatic history. Tinel’s sign (pain provoked by tapping the nerve) is positive over the compression site. Nerve conduction studies confirm the diagnosis. Treatment: activity modification, orthotics, injections, or surgical decompression.
Foot or Ankle Pain? We Can Help.
Balance Foot & Ankle — Howell & Bloomfield Township, MI
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Ankle Pain Without an Injury? 7 Causes You Might Not Expect
Ankle pain does not always follow a specific injury. Arthritis, tendon degeneration, nerve entrapment, and other conditions can cause gradual ankle pain. Dr. Tom Biernacki identifies the hidden cause and provides targeted treatment.
Learn About Ankle Pain Treatment | Book Your Appointment | Call (810) 206-1402
Clinical References
- Martin RL, et al. Ankle stability and movement coordination impairments: ankle ligament sprains revision 2021. Journal of Orthopaedic and Sports Physical Therapy. 2021;51(4):CPG1-CPG80.
- Bernstein J. In brief: ankle pain without trauma. Clinical Orthopaedics and Related Research. 2012;470(3):956-957.
- DiGiovanni CW, Greisberg J. Foot and Ankle: Core Knowledge in Orthopaedics. Mosby Elsevier. 2007.
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Howell Office
3980 E Grand River Ave, Suite 140
Howell, MI 48843
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Bloomfield Hills Office
43700 Woodward Ave, Suite 207
Bloomfield Hills, MI 48302
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Same-week appointments available at both locations.
Book Your AppointmentMore Podiatrist-Recommended Foot Health Essentials
Hoka Clifton 10
Max-cushion everyday shoe — podiatrist favorite for walking and running.
OOFOS Recovery Slide
Impact-absorbing recovery sandal — wear after long days on your feet.
As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. Product recommendations are based on clinical experience; prices and availability shown above update live from Amazon.
When to See a Podiatrist
If foot or ankle pain has been bothering you for more than a few weeks, home care alone may not be enough. Balance Foot & Ankle offers same-week appointments at our Howell and Bloomfield Hills clinics — no referral needed in most cases. Bring your current shoes and a short list of symptoms and we’ll build you a treatment plan in one visit.
Call Balance Foot & Ankle: (810) 206-1402 · Book online · Offices in Howell & Bloomfield Hills
Watch: Dr. Tom explains
Podiatrist-recommended products
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Ankle support for arthritis, tendinopathy, and chronic instability.
View on Amazon →Arch support addressing biomechanical causes of non-traumatic ankle pain.
View on Amazon →Cryotherapy for inflammatory ankle conditions.
View on Amazon →Topical relief for chronic ankle discomfort.
View on Amazon →Related resources
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Same-week appointments · Howell & Bloomfield Hills · 4.9★ (1,123+ reviews)
☎ (810) 206-1402Book Online →PowerStep Dynamic Ankle Stability Sock (DASS)
Best for: Chronic ankle instability · Repeat ankle sprains · Proprioception training · Athletes returning to play
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“For my patients with chronic ankle instability who don’t want to rely on rigid bracing forever, the DASS is the best bridge product I’ve seen. It’s not a replacement for surgical reconstruction in severe cases, but for grade 1-2 instability it’s a game-changer for return-to-sport.”
Dr. Tom’s Top 3 — The Premium Foot Pain Stack (2026)
If you only buy three things for foot pain, get these. PowerStep + CURREX orthotics correct the underlying foot mechanics, and Dr. Hoy’s pain gel delivers fast topical relief. This is the exact stack Dr. Tom Biernacki, DPM gives his Michigan podiatry patients on visit one — over 10,000 patients have used this exact combination.
Dr. Tom Biernacki, DPM is a board-certified podiatrist + Amazon Associate. Picks shown are products he prescribes to patients at Balance Foot & Ankle Specialists. We earn a commission on qualifying purchases at no extra cost to you. All products independently tested + reviewed for 30+ days minimum. Last verified: April 28, 2026.
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Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.
- Plantar Fasciitis: Diagnosis and Conservative Management (PubMed)
- Plantar Fasciitis (APMA)
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)
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