Back of Ankle Pain (Foot, Walking, Running, Morning): 7 Causes
Last updated on July 26th, 2018 at 04:31 pm
Question: What causes back of ankle pain when walking? When should I see my doctor if the back of my foot hurts?
3 in 4 Americans will experience an ankle pain at one point in their lifetime. So, if you are experiencing back of foot pain, you should not feel alone.
Your ankle is important for movement, and if there is an injury to your ligament, bones or tendons, you will experience mild or severe foot pain.
In mild cases, you may only experience mild pain and swelling that resolve within 24 hours. In severe cases, there is a fracture of bones, tear of ligaments or acute inflammation of your tendons.
Foot Anatomy Explained
Your ankle joint is made up of three bones. The shin bones (tibia and fibula) and the talus bone. The outer end of the ankle joint form the lateral malleolus (an extension of the fibula), while the inner side of the ankle joint form the medial malleolus (an extension of the tibia bone).
At the back of the foot is the calcaneus which connects to other bones of the ankle through ligament and joints.
Most importantly are the tendons that run behind the medial and lateral malleoli and those that move down from your leg and attaches to your heel bone.
These tendons can get hurt and inflamed resulting in pain at the back of the leg and foot. The common tendons that when hurt cause back of foot pain are
- Peroneal tendons
- Posterior tibial tendon
- Achilles tendon
Having said that, while the back of foot pain may be due to tendinopathies (a general term for tendon inflammation), back of ankle pain may also result from
- Ankle Sprain
- Osteoarthritis
- Posterior impingement syndrome
So, if your back foot hurt for days and you can’t walk properly or exercise, it is important you see your doctor for a check-up. 
Here are some questions you will be asked about your foot by your doctor
- When did back of foot pain start?
- Do you experience swelling of the back of foot?
- Any preceding injury or unexpected twisting of your ankle joint?
- Do you wear tightly fitted shoes that press on your ankle during walking or running?
- Is back of ankle pain worst in the morning?
- Does taking a rest relieve back of ankle pain?
This article explains the causes of back of ankle pain and treatment options available.
What causes Back of Ankle pain?
Back of ankle pain may be due to a minor injury. If this is the case, in a few days, pain and swelling disappear, and you will feel better. However, if back of foot pain is worsening and you can’t move around freely, it is essential to see your doctor. Here are common reasons why the back of your foot hurts
1. Achilles tendonitis
Achilles tendonitis is a common cause of back of ankle pain, and in simple terms, means the inflammation of the Achilles tendon.
Anatomically, the Achilles tendon connects the muscles of the calf to the heel bone. The Gastrocnemius and soleus muscle forms the Achilles tendon that attaches to the calcaneus (the heel bone). This tendon is particularly crucial for plantarflexion of the ankle (that is, movement of your foot toward the back of the leg).
During trauma, degeneration or inflammation of the Achilles tendon, swelling and pain in the back of the ankle is a common symptom.
What causes Achilles tendonitis to happen?
The most common cause of Achilles tendonitis is an injury to the Achilles tendon from sports, especially those that involve jumping or diving. Other causes are the side effect of medications such as fluoroquinolones.
Also, overuse of the calf muscles and Achilles tendon that is common among athletes can cause Achilles tendonitis
What to do?
If you experience swelling and pain at the back of the foot, it possibly due to an Achilles tendon problem. Therefore, it is essential to see your doctor.
Frequently, it is possible to diagnose Achilles tendonitis form its symptoms which are
- Back of foot pain worse during and after walking
- Back of foot swelling
- The stiffness of the ankle joint
Also, your doctor will request for other investigations such as ankle x-ray, MRI and perform a simple examination of your foot and ankle.
Treatment of ankle tendonitis involves
- Resting the leg, foot, and tender ankle to prevent further inflammation to your Achilles tendon
- Using ice on the back of your ankle to help subside swelling
- Using elastic bandages at the affected foot or ankle
- Leg elevation
- Taking anti-pain medication (non-steroidal anti-inflammatory drug) like Ibuprofen, Naproxen
- Use of corticosteroid may help
2. Peroneal tendonitis
Another cause of swelling and pain at the back of the ankle is peroneal tendonitis that happens when the peroneal tendon gets inflamed.
Anatomically, two peroneal tendons run from your legs downwards passes behind the lateral malleolus and get attached to the 5th metatarsal bone and the inside of the foot arch.
During repetitive usage of your foot, especially running, playing football, basketball, there is an increased risk of injury to the peroneal tendon due to friction between the bone and tendon.
Other causes of peroneal tendonitis are long-term use of tightly fitted footwears, high foot arch, and a sudden increase in the intensity of your routine exercise.
What are the symptoms to expect?
If you have peroneal tendonitis, you will experience pain at the back of foot and ankle. Other symptoms are
- Pain on the outside of the foot
- Swelling of the back of the ankle
- Posterior ankle pain that eases at rest and worsens while walking
What to do for peroneal tendonitis?
Talk to your doctor if you feel posterior foot pain when rolling your foot inwards or outwards. An X-ray and MRI will be needed to check if there are other pathologies like a fracture
Usually, the pain will subside after taking a rest for a while. Other ways to help are
- Using an ice pack to subside pain and swelling
- bracing
- Painkillers
- Cortisone injection
3. Posterior tibial tendonitis
Posterior tibial tendon, when injured or inflamed, can cause pain at the back of the foot.
Anatomically, the posterior tibial tendon extends from your legs, moves down to the inner side of the foot below the medial malleolus and gets attached to the arch of the foot.
If the posterior tibial tendon gets partly or entirely torn, a painful foot is not unexpected.
What are symptoms of posterior tibial tendonitis?
- Pain on back of ankle when walking or running
- Pain and swelling on the inner side of the ankle and foot
- Flattened foot
- Inward rolling of the foot and ankle
What to do?
Swelling at the back and inside the foot is because of a torn posterior tibial tendon. It is important you see your doctor to evaluate the severity of tendon tear.
In mild cases, the RICE therapy will help. This involves resting, ice, compressing bandages, and leg elevation. Painkillers will also be prescribed.
However, in severe cases, surgery may be required by your doctor.
4. Ankle Sprain
Back of foot pain can also happen if you twist your ankle from running, walking, or high-intensity exercise. If this happens, you will have top of foot swelling, and back foot pain.
5. Arthritis
Arthritis is the inflammation of your bone, and it is more prevalent in the elderly. Symptoms include stiffness, swelling, and pain in the ankle and foot. If pain affects only one foot, its likely because of wear and tear of your joint cartilages (osteoarthritis).
However, if you have pain in both ankles, foot, knees, and hip, it likely because of systemic arthritis (Rheumatoid arthritis).
Treatment involves painkillers and steroid injections.
BACK OF FOOT PAIN (FAQ)
What causes pain in the back of ankle above heel?
If you are experiencing pain in the back of the foot above the heel, it is likely you have degenerative or inflammatory changes of the Achilles tendon.
The Achilles tendon is just located at the back of your leg and extends downwards to the heel bone where it is attached. During inflammation of the Achilles tendon, it is not uncommon to feel pain at the back of your ankle above the heel bone. Other symptoms are swelling and joint stiffness.
What causes back of ankle pain in the morning?
Achilles tendonitis, osteoarthritis, and plantar fasciitis are common reasons you will experience pain in the back of foot when getting out of bed in the morning.
See your doctor for help
What causes back of ankle pain no swelling?
If you experience back of foot pain no swelling, it could be due to
- Achilles tendonitis
- Posterior tibial tendonitis
- Ankle Sprain
- Peroneal tendonitis
- Stress fracture of the heel bone
What causes pain in the back of ankle when flexing foot?
Ordinarily, stretching and flexing your foot should not cause pain. If they do, it means something is possibly wrong.
The reason this happens is Achilles tendon injury which causes pain when flexing the foot, stiffness, and ankle swelling.
