If you are experiencing pain at the back of your ankle, the chances are that it is due to one of three possible problems. These are achilles tendonitis, ankle bursitis and ankle arthritis.
In this article, we will briefly describe the symptoms that will likely accompany each of these 3 medical conditions. This will allow you to make an educated guess as to which (if any) of them might be present.
Of course, we suggest that the first step you should take if you are experiencing pain behind the ankle is to visit your doctor. In this article, we also briefly describe the treatment recommendations you will probably receive if your doctor confirms your suspicions.
We should also point out that pain behind the ankle can be due to other factors. The 3 we have mentioned above are not the only possible culprits. However, they are the most common causes of ankle pain when it occurs behind the ankle.
Ankle sprains are another common cause of ankle pain. However, they usually do not cause pain behind the ankle.
This is an overuse injury of the Achilles tendon – the band of thick tissue connecting your calf muscles to your heel bone. Continued overuse of the tendon leads to a failed healing response. This, in turn, leads to degenerative changes in the tendon If you are a frequent runner and have increased the intensity and/or duration of your runs, your ankle pain is likely due to this cause. The condition is alternatively known as Achilles tendinitis.
Achilles tendonitis pain usually starts as a dull ache just above the heel after you have completed a run or some other sports activity. As time goes on, you may experience increased pain severity after a run. Stair climbing or sprinting may also aggravate the pain.
The back of your foot (above the heel) may also feel tender and stiff, especially just after awakening in the morning. This will usually go away with low level activity.
Our suggestion would be to see a doctor for medical advice, diagnosis and treatment. Left untreated, some cases of Achilles tendonitis may end up as Achilles tendon ruptures.
An important treatment measure is to identify and remove any causative factors in order to relieve symptoms.
Most likely, however, your condition will be treatable at home using self care methods. Your doctor will likely prescribe a period of rest (suspending intense physical activity) to allow your tendon to recover naturally. This can be achieved by using braces and immobilisation with a cast or pneumatic walking boot. Pain relieving medication may be prescribed if the pain is severe. Medications that can be used include anti-inflammatory drugs like advil (ibuprofen) or tylenol (paracetamol). Corticosteroid injections are sometimes used to reduce pain and swelling.
Many doctors will also refer you to a therapist. There, you will receive a program of physical therapy exercises to stretch and strengthen your Achilles tendon and calf muscles.
A podiatrist can also construct a shoe insert that will raise your heel slightly in the shoe. This will ease the tension on the Achilles tendon and reduce the forces exerted on it by walking and running. A change of shoes or correction of malalignments can, also, lead to an improvement in symptoms.
This injury is caused by irritation and inflammation of one or more bursae of the ankle. The bursae are small fluid filled sacs in each joint that sit between the bones and tendons. They make it easier to move the joint.
In the case of the ankle, there is one particular bursa that can cause pain behind your ankle. It’s called the retrocalcaneal bursa and is situated between the heel bone and Achilles tendon. If that bursa becomes inflamed, the condition is known as anterior Achilles tendon bursitis and it causes pain, redness and swelling between the heel bone and the Achilles tendon at the back of your ankle. There is tenderness on direct palpation.
In addition to the pain alluded to above, you may also experience pain at the back of your heel when flexing your foot. Redness of the area above the heel (as described above) and fever or chills (if the bursitis is caused by an infection) may also be present.
Your doctor will, upon diagnosing ankle bursitis, likely recommend conservative treatment measures.You will probably be advised to rest your ankle for a few days and avoid intense physical activity.
In addition, your doctor will likely recommend applying an ice pack every few hours. If the pain is severe, you may also be advised to take pain relieving medication or anti inflammatories like advil (ibuprofen).
In addition to the above, wearing more roomy shoes will help reduce the pressure on and irritation of the bursae.
Arthritis can take many forms of which the most common are:
Together with pain behind your ankle, arthritis can cause joint stiffness, swelling and redness. Unlike the other two causes of posterior ankle pain discussed above, symptoms (particularly the stiffness) are usually worst just after awakening. Redness is typically present in gout, but is not a common feature of rheumatoid arthritis and osteoarthritis.
Unlike the other two conditions discussed above, there is no fundamental cure for ankle arthritis. Instead, doctors try to control the rate of progression of the disease and reduce its impact on your lifestyle.
Once arthritis has been diagnosed, your doctor will suggest a combination of medication, lifestyle changes, hot/cold therapy and physical therapy. The precise combination of treatments will depend on the type of arthritis you have and how far it has progressed.
For rheumatoid arthritis, there are medications called disease modifying anti-rheumatic drugs which can slow down the progression of the disease.
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