Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. 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

1. 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.
2. Bernstein J. In brief: ankle pain without trauma. Clinical Orthopaedics and Related Research. 2012;470(3):956-957.
3. DiGiovanni CW, Greisberg J. Foot and Ankle: Core Knowledge in Orthopaedics. Mosby Elsevier. 2007.