Pain in the back of the ankles when walking can be a frustrating experience, making simple movements challenging. This discomfort can range from a dull ache to sharp, intense pain. Understanding the reasons behind this type of ankle pain is key to finding relief and resuming an active lifestyle.
Common Causes of Pain in the Back of the Ankle
Achilles Tendinitis
Achilles tendinitis is inflammation of the Achilles tendon, connecting calf muscles to the heel. Symptoms include stiffness, tenderness, and pain, worsening with activity (walking, running, climbing stairs). Pain may be more noticeable in the morning and lessen with movement. Overuse, sudden increases in exercise intensity, tight calf muscles, or improper footwear can strain the tendon.
Retrocalcaneal Bursitis
Retrocalcaneal bursitis is inflammation of the bursa, a small fluid-filled sac between the Achilles tendon and the heel bone. It cushions to reduce friction during movement. When inflamed, it causes localized pain and swelling at the back of the heel, which can be tender to the touch. Tight-fitting shoes or repetitive ankle motion, like running uphill, can irritate this bursa.
Haglund’s Deformity (Pump Bump)
Haglund’s deformity, often called “pump bump,” is a bony enlargement on the back of the heel bone where the Achilles tendon attaches. This protrusion can irritate nearby soft tissues, including the Achilles tendon and retrocalcaneal bursa, leading to pain and inflammation. The condition often presents as a noticeable bump on the heel, with pain that intensifies when wearing shoes with rigid backs. High arches or a tight Achilles tendon can also contribute to its development.
Posterior Ankle Impingement
Posterior ankle impingement is pain from the compression of tissue or bone at the back of the ankle joint. This compression often occurs during forceful or repetitive plantar flexion (pointing the foot downwards), common in activities like ballet, soccer, or downhill running. Symptoms include sharp pain deep in the back of the ankle during these movements, sometimes with a dull ache and swelling after activity.
Stress Fractures
Stress fractures are tiny cracks in bones, commonly in the calcaneus (heel bone) or tibia (shin bone), due to repetitive stress or overuse. Unlike acute fractures, stress fractures develop gradually, causing a dull, aching pain worsening with weight-bearing activities like walking or standing. Pain may ease with rest but can become constant; the affected area might feel tender or warm.
Nerve Entrapment (e.g., Sural Nerve)
Nerve entrapment occurs when a nerve becomes compressed or irritated by surrounding tissues, causing pain and other sensations. The sural nerve, in the lower leg, responsible for sensation to parts of the calf and outer foot, can be affected. Sural nerve entrapment can cause burning, tingling, numbness, or sharp pain in the back of the ankle, often extending into the outer foot. It can result from scar tissue, tight footwear, or ankle sprains.
Initial Steps for Relief at Home
When experiencing pain in the back of the ankles, several self-care measures can help alleviate discomfort. Applying the R.I.C.E. protocol is a common starting point:
- Rest: Avoid activities that worsen pain, opting for low-impact movements like swimming.
- Ice: Apply ice packs to the painful area for 15-20 minutes every 2-3 hours to reduce swelling and discomfort.
- Compression: Use an elastic bandage wrapped around the ankle to control swelling, ensuring it is not too tight.
- Elevation: Raise the affected foot above heart level, especially when resting, to reduce swelling.
Over-the-counter pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen sodium, manage pain and reduce inflammation. These medications are available in pill form or as topical gels for localized relief. Follow dosage instructions and avoid prolonged use without medical consultation.
Gentle stretching and strengthening exercises for the calf and Achilles tendon promote flexibility and support once initial pain subsides. A calf stretch involves leaning against a wall with one leg behind, keeping the heel on the ground and bending the front knee until a gentle stretch is felt. A heel drop stretch on a step, with the ball of the foot on the edge, targets the Achilles tendon as the heel drops downwards. Perform these exercises cautiously, stopping if any pain occurs.
Selecting appropriate footwear is a simple yet effective step. Wearing supportive shoes that provide adequate cushioning and arch support distributes pressure evenly and reduces ankle strain. Avoiding high heels or shoes with rigid backs that rub against the heel can prevent further irritation, especially in conditions like Haglund’s deformity or retrocalcaneal bursitis. Over-the-counter orthotics or heel cups can also provide support and comfort.
When to Seek Professional Medical Advice
While home remedies can offer temporary relief, certain signs indicate the need for professional medical evaluation to prevent further complications. Persistent pain that does not improve after a few days of consistent home care, or pain that worsens over time, warrants a doctor’s visit. This could signal an underlying issue that requires specific medical intervention.
Severe or sudden pain, particularly if it occurred after an injury like a fall or twist, should be promptly assessed by a healthcare professional. An inability to bear weight on the affected ankle, or significant difficulty walking, are strong indicators of a more serious injury, such as a fracture or severe sprain. Any visible deformity of the ankle, such as an unusual lump or a misshapen appearance, along with significant swelling or bruising, requires immediate medical attention.
Numbness, tingling, or weakness in the foot or toes accompanying the ankle pain can suggest nerve involvement, which needs prompt evaluation. Signs of infection, including redness, warmth, increased tenderness in the area, or a fever above 100 degrees Fahrenheit (37.8 degrees Celsius), also necessitate urgent medical care. Ignoring these symptoms can lead to prolonged recovery times or more complex issues.
Professional Treatment Approaches
When ankle pain persists despite home care, a healthcare professional will begin with a physical examination to assess the affected area, check for tenderness, and evaluate range of motion. Imaging tests may be ordered to understand the underlying cause:
- X-rays: Visualize bone structures and rule out fractures.
- MRI: Used for detailed images of soft tissue damage (ligaments, tendons) or subtle bone issues.
- CT scan: Provides detailed bone information.
- Ultrasound: Assesses ligaments and tendons in real-time.
Physical therapy focuses on restoring strength, flexibility, and proper ankle function. A physical therapist designs a personalized program including exercises to strengthen calf muscles, improve ankle stability, manual therapy, and therapeutic ultrasound. The goal is to gradually increase the ankle’s capacity for movement and weight-bearing.
Doctors may prescribe stronger anti-inflammatory drugs or muscle relaxants to alleviate pain and reduce inflammation. These are used for limited durations to manage acute symptoms. Injections may also be considered for targeted relief. Corticosteroid injections reduce inflammation and pain directly in the affected bursa or joint. Platelet-rich plasma (PRP) injections, derived from the patient’s own blood, support the body’s natural healing processes by delivering concentrated growth factors to injured tissues.
Orthotics and bracing provide external support and improve foot mechanics. Custom-made orthotic inserts, designed to fit a patient’s foot, correct alignment and distribute pressure more evenly. Ankle braces or supportive devices stabilize the joint, reduce excessive movement, and aid healing, particularly after sprains or for chronic instability.
Surgery is a last resort for chronic or severe ankle pain unresponsive to conservative treatments. Procedures vary by condition. Ankle impingement surgery might remove bone spurs or trapped tissues, while tendon repair addresses tears or chronic tendinopathy. For advanced arthritis, ankle fusion (joining bones) or total ankle replacement may alleviate pain and restore some mobility.