Pain in the Back of the Ankle Above the Heel

Pain in the back of the ankle above the heel might feel like a minor inconvenience at first, but lingering discomfort can significantly disrupt your daily activities. I frequently see patients with this complaint, and there are several potential culprits to consider. Let’s dive into the common causes, symptoms, and ways to find relief.

Understanding the Anatomy

The area behind your ankle and above your heel is home to a key structure – your Achilles tendon. This strong, fibrous cord connects your calf muscles to your heel bone, enabling you to walk, run, and jump. Problems within the tendon itself or surrounding structures can lead to pain in this region.

Common Causes of Pain Behind the Ankle

Achilles Tendinitis: Overuse or repetitive stress on the Achilles tendon can lead to inflammation, known as Achilles tendinitis. This may present as a dull ache or a sharp, stabbing pain. There are two main variations:
- Insertional Achilles Tendinitis: Affects the lower portion of the tendon where it attaches to the heel bone.
- Non-insertional Achilles Tendinitis: Occurs a few inches above the heel in the mid-portion of the tendon.
Retrocalcaneal Bursitis: Bursae are fluid-filled sacs that reduce friction around joints. The bursa behind your heel (retrocalcaneal bursa) can become inflamed, causing pain and swelling.
Haglund’s Deformity: A bony enlargement on the back of your heel can irritate the Achilles tendon and bursa, leading to pain. Some people know it as a pump bump.
Achilles Tendon Rupture: In severe cases, the Achilles tendon can tear partially or completely. This often occurs suddenly and causes intense pain, swelling, and difficulty walking. Sometimes, an audible sound can be heard when it breaks.

Symptoms: What Does It Feel Like?

Besides the location of the pain, here’s what you might experience:

Pain that worsens with activity and improves with rest
Stiffness in the morning or after inactivity
Tenderness or swelling around the Achilles tendon or bursa at the back of the heel
A popping or snapping sensation in the tendon (may indicate a rupture)

When to See a Podiatrist

If you experience persistent discomfort, severe pain, swelling, or a sudden ‘pop’ in the back of your ankle, it’s crucial to consult a podiatrist. Early diagnosis and treatment can prevent lingering issues.

Diagnosis & Treatment

A podiatrist or another practitioner will conduct a thorough examination, including:

Physical exam: Your practitioner will evaluate your strength, range of motion, and the affected area.
Medical history: Discussing previous injuries, activities, and any underlying health conditions.
Imaging: X-rays, ultrasounds, or MRIs may be necessary to visualize the tendon, bone, and surrounding structures.

Treatment typically revolves around:

RICE: Rest, Ice, Compression, and Elevation are the first line of conservative treatment.
NSAIDs: Over-the-counter pain relief can reduce inflammation.
Physical Therapy: Stretching and strengthening exercises guided by a therapist are crucial for long-term management
Orthotics: Custom shoe inserts can provide support and correct foot mechanics that contribute to the problem. I often issue a pair of heel raise, my patients find them helpful.
Immobilization: Depending on the severity, a boot or cast may be necessary to allow the tendon to heal.
Extracorporeal Shockwave Therapy (ESWT): This treatment causes microtrauma to stimulate healing.
Surgery: In rare cases, surgery may be needed to repair the tendon or remove bony growths.

Prevention

Warm-up: Properly warm up before exercising.
Stretching: Maintain flexibility in your calf muscles and Achilles tendon.
Gradual Progression: Increase the intensity and duration of activity gradually.
Proper Footwear: Wear supportive shoes during physical activity.

Prognosis

The prognosis for pain in the back of the ankle above the heel is generally good, especially with early diagnosis and appropriate treatment. Most cases of Achilles tendinitis, bursitis, and even Haglund’s deformity can be successfully managed with conservative measures like rest, physical therapy, and orthotics.

While recovery may take time, the majority of patients experience significant pain reduction and a return to normal function. In cases of severe Achilles tendon ruptures, the prognosis is still favourable with surgical intervention. However, the rehabilitation period may be longer.

Conclusion

Pain in the back of the ankle above the heel should never be ignored. Whether it’s a dull ache or an intense, debilitating discomfort, understanding the underlying cause is the first step towards finding relief. Don’t hesitate to consult a podiatrist for a thorough evaluation and a treatment plan tailored to your specific needs. With appropriate care, most people can overcome this type of pain and return to their favourite activities. Good luck!

FAQs

How long does it take for Achilles tendinitis to heal?

Mild cases may improve within weeks. However, full recovery can take several months, especially with more severe injuries.

Can I still exercise with pain in the back of my ankle?

It depends on the severity. Sometimes low-impact activities are possible, but if the pain is significant, rest is crucial. Your podiatrist will provide specific guidance.

Is surgery always necessary for an Achilles tendon rupture?

Not always. It depends on the severity of the rupture and your individual factors. However, surgery often offers the best chance for full functional recovery.

What’s the difference between Achilles tendinitis and bursitis?

Achilles tendinitis involves inflammation of the tendon itself. Meanwhile, bursitis affects the fluid-filled sac located behind or in front of the tendon. The pain location may be slightly different. Bursitis pain can usually be felt at the sides.

I have a bony bump on the back of my heel. Could this be related to my pain?

Yes, a bony bump (Haglund’s Deformity) can irritate the Achilles tendon and bursa, causing pain.

References

Brukner, P., & Khan, K. (2017). Clinical Sports Medicine (5th ed.). McGraw Hill Australia.
Li, H.-Y., & Hua, Y.-H. (2016). Achilles tendinopathy: Current concepts about the basic science and clinical treatments. Biomed Research International, 2016, Article 6492597. https://doi.org/10.1155/2016/6492597
Yuen, W. L. P., Tan, P. T., & Kon, K. K. C. (2022). Surgical treatment of Haglund’s deformity: A systematic review and meta-analysis. Cureus, 14(7), Article e27500. https://doi.org/10.7759/cureus.27500

Note From Us: It’s always best to consult with a podiatrist or other medical professional for personalized diagnosis and treatment recommendations.