A burning sensation in the ankle suggests a problem with the body’s nerve signaling system. This feeling is often described as an electrical shock, tingling, or actual heat, falling under the umbrella of abnormal nerve sensations. The symptom indicates that sensory nerves in the lower leg and foot are irritated, damaged, or malfunctioning. Causes range from simple physical compression to complex systemic diseases.
Understanding Neuropathic Pain
The feeling of burning pain arises from neuropathic pain, which is distinct from the pain caused by injuries like a sprain or broken bone. When nerves are damaged, they misfire or become hyper-sensitized. This malfunction causes the nerve to spontaneously generate impulses, which the brain interprets as a painful sensation like fire or electricity (paresthesia or dysesthesia).
Peripheral nerves in the ankle, such as branches of the tibial nerve, have specialized channels that respond to heat and pain. When injured, these channels can become altered and overactive, causing the nerve to fire signals without an external stimulus. This ectopic activity means the nerve itself generates the pain signal, which the brain registers as a burning sensation projected to the ankle and foot. This altered signaling can occur due to direct trauma, prolonged compression, or chemical disruption from underlying diseases.
Localized Nerve Compression
A common cause for localized burning in the ankle is Tarsal Tunnel Syndrome (TTS), a form of entrapment neuropathy similar to carpal tunnel in the wrist. This condition involves the compression of the posterior tibial nerve as it passes through the narrow tarsal tunnel on the inside of the ankle. The tunnel is a confined space formed by ankle bones and the flexor retinaculum ligament.
Any factor that reduces the space within the tunnel can squeeze the tibial nerve, causing pain, numbness, tingling, or a burning feeling in the ankle and bottom of the foot. Local causes include physical injuries, such as a severe ankle sprain that causes swelling and nerve compression. Other factors are abnormal growths like a ganglion cyst, a bone spur, or a swollen varicose vein occupying space within the tunnel. Even physical mechanics, such as flat feet or excessively tight footwear, can lead to strain and compression on the posterior tibial nerve.
Systemic Conditions Causing Neuropathy
When the burning sensation is present in both ankles and feet, it often indicates generalized peripheral neuropathy, which affects nerves throughout the body. Systemic diseases frequently cause this pattern because damage begins in the longest nerve fibers first, those reaching the feet and ankles. This is sometimes referred to as a “dying-back” neuropathy because the farthest nerve axons are most vulnerable to metabolic or toxic disruption, creating a “stocking-glove” pattern of symptoms.
Diabetes Mellitus is the most frequent cause, where persistently high blood sugar levels damage the small blood vessels supplying the nerves. This metabolic damage disrupts the nerve’s ability to repair itself, leading to nerve fiber dysfunction and the characteristic burning pain. Other systemic issues contributing to generalized nerve damage include Vitamin B12 deficiency and chronic alcohol consumption. Certain medical treatments, such as chemotherapy, can also be neurotoxic and cause this length-dependent neuropathy as a side effect.
Inflammatory and Infectious Causes
Not every instance of burning pain stems from direct nerve damage; intense inflammation or infection in the joint or surrounding tissue can create a similar sensation. Conditions like Gout, an inflammatory type of arthritis, cause severe joint pain often described as burning, particularly in the ankle or big toe. Gout occurs when high levels of uric acid form sharp crystals in the joint, triggering an intense immune response characterized by redness, swelling, and heat.
A serious bacterial skin infection called cellulitis can also cause a burning sensation accompanied by warmth, swelling, and visible redness in the ankle area. This pain is primarily nociceptive, caused by the activation of pain receptors due to tissue inflammation, rather than nerve malfunction. The affected area in cellulitis is typically warm to the touch, and the pain is accompanied by systemic signs like fever or chills, distinguishing it from most neuropathic conditions.
When to Consult a Healthcare Professional
While minor, temporary burning sensations may resolve with rest, certain symptoms require prompt medical evaluation to prevent serious complications. You should seek immediate attention if the burning pain has a sudden onset, is accompanied by a fever over 100 degrees Fahrenheit, or if you notice spreading redness, pus, or an open wound. These signs may indicate a severe infection like cellulitis, which requires urgent treatment.
It is advisable to schedule a visit if you experience an inability to bear weight on the ankle, or if the burning pain is persistent, worsening, or associated with new numbness or weakness. For individuals with systemic conditions like diabetes, any non-healing foot or ankle wound should be examined immediately. A healthcare professional can perform a comprehensive evaluation to accurately diagnose the underlying cause, allowing for targeted management.