Pain in the back of the ankle when flexing the foot is a common symptom that can cause significant discomfort. It often signals an issue with tendons, bones, or soft tissues in the lower leg. Understanding its potential origins is important, as this pain can interfere with daily activities and physical movement.
Common Causes of Pain
Achilles tendinopathy is a frequent cause of pain at the back of the ankle. This condition involves inflammation or degeneration of the Achilles tendon, which links the calf muscles to the heel bone. Pain often occurs when pushing off the ground or stretching the tendon, and dorsiflexion (upward foot flexion) can worsen this discomfort. Overuse, sudden increases in physical activity, or inadequate warm-ups contribute to its development.
Retrocalcaneal bursitis is another source of discomfort, characterized by inflammation of the bursa. This small, fluid-filled sac is positioned between the Achilles tendon and the heel bone (calcaneus). Pain is typically felt at the back of the heel and can worsen with dorsiflexion or pressure from footwear. Repetitive friction or direct pressure often irritates the bursa, leading to inflammation.
Haglund’s deformity, a bony enlargement on the heel bone, can also cause back-of-ankle pain. This protrusion is sometimes called a “pump bump” due to its association with certain types of shoes. The bony growth can irritate the adjacent Achilles tendon or retrocalcaneal bursa, leading to pain. Pain often intensifies with upward foot flexion (dorsiflexion) or friction from shoe backs.
Posterior ankle impingement syndrome involves the pinching of soft tissues or bony structures at the rear of the ankle joint. This condition often occurs during extreme plantarflexion (pointing the foot downwards). Pain in the back of the ankle from any foot movement, including plantarflexion, can indicate this syndrome. Repetitive motions or acute trauma can lead to the entrapment of these structures, causing pain.
When to Seek Professional Help
Consult a healthcare professional if ankle pain persists despite rest and self-care measures. Worsening pain, an inability to bear weight on the affected foot, or signs of infection (redness, warmth, swelling, fever) should prompt a medical evaluation. Sudden, severe pain or suspected bone fracture after an injury also requires immediate attention.
Diagnosis and Treatment Options
A healthcare provider begins diagnosis with a physical examination of the ankle and a review of medical history, inquiring about the onset of pain, aggravating factors, and any previous injuries. Imaging studies are used to understand the underlying cause. X-rays identify bony abnormalities like Haglund’s deformity, while magnetic resonance imaging (MRI) provides detailed views of soft tissues such as tendons and bursae.
Treatment for back-of-ankle pain begins with conservative approaches to reduce inflammation and promote healing. The RICE protocol (Rest, Ice, Compression, and Elevation) is recommended for acute symptoms. NSAIDs can alleviate pain and swelling.
Physical therapy, including targeted stretching and strengthening exercises, improves flexibility and muscle support. Custom orthotics or footwear modifications provide support and reduce irritation, correcting biomechanical imbalances. If conservative treatments are insufficient, advanced interventions or surgery may be considered. These are reserved for severe cases, such as significant tendon tears or persistent impingement that impairs function.
Prevention and At-Home Care
Preventative measures reduce the likelihood of developing back-of-ankle pain. These include a proper warm-up before physical activity, gradually increasing activity levels, and wearing appropriate footwear that provides adequate support and cushioning. Regularly stretching calf muscles and the Achilles tendon helps maintain flexibility and prevents tightness. Maintaining a healthy body weight reduces stress on ankle joints.
For mild pain at home, rest the affected ankle to reduce inflammation. Apply ice for 15-20 minutes several times daily to reduce swelling and discomfort. Gentle stretching within a pain-free range promotes flexibility and blood flow.
Over-the-counter pain relievers, such as ibuprofen or acetaminophen, can manage mild to moderate pain. Choosing supportive footwear, even during daily activities, provides comfort and prevents aggravation. Listening to the body and avoiding activities that worsen pain are important for effective at-home care.