If you recently sprained your ankle or have been dealing with a condition like tendinitis or arthritis, ankle pain at night may not come as a surprise. But when you aren’t nursing an injury, you may be confused why your ankles suddenly feel achy when you plop down on the couch or hop into bed. This type of late-in-the-day ankle pain is actually common, says Kristin Vinci, PT, DPT, a physical therapist at Hinge Health. “I’ve seen people who feel fine during the day, and then, in the evening, they notice their ankles hurt or feel stiff.”

It’s understandable when you think about everything your ankles have to withstand during the day. They work hard to help you stand tall, shift your weight, walk, climb stairs, run, and do many other activities. In the process, your ankles have to bear an impressive load — about five times the force of your body weight with every step you take. While they are usually up to the task, after a long day, they may be in need of a little attention and care.

“Ankle pain at night doesn’t necessarily mean something is wrong or that you have an injury,” reassures Dr. Vinci. “The pain is an alert that you may need to work on strengthening parts of your body that support your ankles in order to decrease sensitivity at nighttime.” A strength and flexibility plan can help your ankles function better with less pain.

Read on to learn more about what causes ankle pain at night and how to relieve and prevent it, especially with exercises from our Hinge Health physical therapists.

Why Is Ankle Pain Worse at Night?

Nighttime ankle pain can be caused by any condition that results in pain during the day, such as ankle injuries, wearing unsupportive shoes, or other medical issues. No matter what’s contributing to your ankle pain, it can be worse at night for a variety of reasons, such as:

• Doing too much during the day. “When you're standing for a long time or are more active than usual during the day, you can build up more fatigue and irritation in some muscles or tendons of the ankle that may cause pain in the evening,” says Dr. Vinci. The fatigue and irritation can also make pain from an ankle sprain, Achilles tendinitis, or arthritis worse. 

• Less activity at night. Conversely, if you plant yourself on the couch for hours after a long day, the lack of activity may increase ankle pain and stiffness. “When you’re sitting down to read a book or watch TV, there’s not as much circulation and blood flow lubricating your ankle joints,” says Dr. Vinci. As a result, the ankle joint and surrounding muscles and tendons can become tight and stiff. “When you get up, you may feel more pain,” she adds.

• Muscle weakness. If the muscles surrounding your ankles are weak, your joints will experience more pressure as you move. To compensate, your ankles may be more likely to roll inward or outward when standing still. Without adequate muscular support, the muscles, tendons, and ligaments around the ankles can become irritated throughout the day, resulting in pain at night.

• Unsupportive shoes. Spending the day in flimsy shoes, high heels, or worn-out footwear, especially if you spend most of your day standing, can contribute to nighttime ankle pain as the lack of support can put more stress on your joints. The cumulative effect can lead to nighttime achiness or pain. 

• Fewer distractions. When you’re busy with work, family, friends, errands, and chores during the day, it can distract you from pain or stiffness. Downtime after a busy day gives you more time to focus on your symptoms. “When you’re less preoccupied, you may start to notice your body a little bit more and zero in on any pain or sensitivity,” says Dr. Vinci. 

• Too much sitting during the day. A lack of movement during the day decreases circulation and can cause fluid retention and swelling, resulting in nighttime ankle pain.

• Circadian rhythms. Your body has an internal 24-hour clock that regulates various processes such as sleep, hormones, metabolism, and body temperature. Pain is also regulated by circadian rhythms with daily fluctuations. According to research, sensitivity to pain can naturally increase at night.

How to Cope When Ankle Pain Strikes at Night

No matter what might be making your ankle hurt at night, there is a lot you can do to ease the pain, including:

• Move a little. While it’s understandable that you may want to limit movement if you’re in pain, gentle stretches and range-of-motion exercises before bed (or if you wake in the middle of the night) can increase blood flow, reducing swelling and stiffness that can cause discomfort. The exercises below are a great place to start.  

• Put your feet up. Elevating your feet can help reduce fluid and swelling that can cause pain. If you’re relaxing on the couch after a long day, elevate your feet on a few pillows or sit with your legs up a wall for a few minutes. 

• Try ice or heat. Icing reduces swelling, inflammation, and nerve and pain sensitivity. Heat increases blood flow and can reduce stiffness. You can apply heat or ice to your ankles as needed for 20 minutes at a time, but avoid using heat to treat a new injury as this can potentially delay healing. 

• Try over-the-counter (OTC) medication. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can be helpful for nighttime ankle pain. It’s important to make sure that you are safely able to take these medications, based on your medical history.

You should check with your doctor if you experience redness or swelling in your ankles that doesn't resolve, severe pain that doesn't let you sleep at night, or temperature or color differences between your legs.

The above PT-recommended exercises can provide on-the-spot relief when your ankles hurt and you can even do some without getting out of bed. These moves gently stretch tight muscles, enhance joint range of motion, increase circulation, and improve nerve function to ease pain, swelling, and stiffness in your ankles.

These strength exercises help build a support system for your ankles. “The more strength and stability you have, the less likely you are to have irritation and inflammation that can cause ankle pain during the day or at night,” says Dr. Vinci.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

More Ways to Prevent Ankle Pain at Night

Along with strengthening your ankles, these additional strategies can help head off nighttime ankle pain.

• Choose supportive shoes. Flip flops or strappy sandals are okay occasionally, but if you are on your feet all day or walk a lot, supportive shoes will do more to protect your ankles. While there’s no perfect shoe that works for everyone, people with ankle pain may do well with a shoe with arch support and a low heel.

• Replace old sneakers. Replacing worn-out shoes can reduce strain on your ankles and keep them feeling strong and stable. As a general rule of thumb, try to replace your shoes every 350 to 450 miles or every six months if you’re moderately active.

• Try orthotics. Shoe inserts can help minimize pressure on your ankles and decrease pain. A 2022 study in the journal Gait & Posture found that orthotics helped to reduce pain while walking among people with arthritis.

• Consider compression socks. If swelling is contributing to your ankle pain, wearing compression socks can help minimize fluid buildup during the day. The tightness may also make you more aware of your posture. “Compression socks can give you more feedback about where your body is in space and might help you be more aware of if you’re rolling in or out on your ankles,” says Dr. Vinci.

PT Tip: Take Breaks

Whether you’re on your feet all day or sitting all day, your ankles will be less achy in the evening if you take time to switch things up, says Dr. Vinci. If you’re doing a lot of walking or standing, take a seat and put your feet up or do some ankle pumps or ankle circles. If you’re sitting a lot, get up and walk around regularly. By breaking up any activity you’re doing for a prolonged period, you can increase circulation to your ankle joints and reduce stiffness and pain.

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References 

1. Daguet, I., Raverot, V., Bouhassira, D., & Gronfier, C. (2022). Circadian rhythmicity of pain sensitivity in humans. Brain, 145(9), 3225–3235. doi:10.1093/brain/awac147

2. Simonsen, M. B., Næsborg-Andersen, K., Leutscher, P. D. C., Hørslev-Petersen, K., Woodburn, J., Andersen, M. S., & Hirata, R. P. (2022). The effect of foot orthoses on gait biomechanics and pain among people with rheumatoid arthritis: a quasi-experimental study. Gait & Posture, 95. doi:10.1016/j.gaitpost.2022.04.016