Pain in the back of the ankles

Common Causes of Pain In The Back of The Ankles


Occasional discomfort at the back of the ankle is not uncommon and may be related to a minor accident or injury. But back of ankle pain that does not go away or seems to get worse may indicate a bigger problem. Learn more about the common causes of pain in the back of the ankles and how to treat the issues for lasting relief.

What Causes Pain in the Back of the Ankles?

Chronic pain in the back of the ankle can make it difficult to stand, walk, and do all of the tasks and activities that usually fill your day. Here are some of the reasons you may be experiencing soreness in this part of the foot.


Pain in the back of the ankles may be a sign of arthritis. Arthritis is an umbrella term that refers to more than 100 different conditions that affect the joints and the tissues and structures that surround and connect them.

While the ankle is often considered a single joint, it actually consists of three joints. The talocrural joint (also known as the true ankle joint) allows the foot to move up and down, the subtalar joint allows the ankle to turn in and out, and the inferior tibiofibular joint allows the ankle to do both movements. Two of the more common types of arthritis often affect the ankle joints.

Osteoarthritis is the “wear and tear” form of arthritis that causes the cartilage that cushions the ends of the bones to breakdown. Without that padding, the bones rub together causing stiffness, mobility issues, and pain in around the ankle.

Rheumatoid arthritis (RA) is a chronic disease that causes the body’s immune system to overreact and attack the body’s joints. For the majority of people with RA, the joints of the feet and ankles are affected.


Bursae are small, fluid-filled sacs that cushion the bones, tendons, and muscles near the joints. Bursitis is inflammation of these sacs, typically caused by repetitive motion. The retrocalcaneal bursa is located by the heel in the back of the ankle, where the Achilles tendon connects the heel bone to the calf muscles.

Overuse of the ankle joint through frequent jumping, walking, or running can inflame this bursa and lead to pain at the back of the ankle. Ankle pain due to bursitis may get worse with activity and feel sore to the touch. A noticeable ‘pump bump’ can appear on the back of the ankle when this bursa gets irritated.

Ankle Sprain

Ankle sprains are common injuries that affect people of all ages and activity levels. According to ChoosePT, 45% of all sports injuries that occur in this country are ankle sprains. Sprains develop when the sturdy, fibrous ligaments that support and stabilize the ankle overstretch and tear. In most cases, the sprain is an inversion injury, which means it was caused by the foot turning inward which will create pain on the outside of the ankle Other areas of the ankle can also be sprained.

Pain and other symptoms of a sprained ankle vary depending upon which ligaments are involved and how severely they are damaged. Pain, bruising, swelling at the back of the ankle are certainly possible with an ankle sprain. A complication of an ankle sprain is called posterior impingement. This is when the capsule of the ankle gets pinched between the bones at the back of the ankle after an ankle sprain. This will cause pain during walking often when pushing off on the affected foot.

Ankle Strain

Strains are similar to sprains, yet they affect the muscles and tendons instead of the ligaments. Ankle strains occur from sudden movements where the ankle turns inward or outward unnaturally. Symptoms of a strain include pain, swelling, and tenderness around the ankle joint.

Achilles Tendinitis and Tendinopathy

The Achilles tendon is the largest tendon in the body. It runs down the back of the lower leg and connects the calf muscles to the heel bone. It is used to walk, run, jump, climb, and stand on one’s tip toes.

While the Achilles can endure significant stressors during intense activity, it is also prone to tendonitis (inflammation of the tendon) and tendinopathy (degeneration of the collagen that forms the tendon.) Pain and swelling at the back of the ankle that gets worse with activity are common signs of a condition affecting the Achilles tendon.

Ankle Fracture

A fracture is a partial or complete break in the bone. An ankle fracture, or broken ankle, can involve one or more bones that form the ankle joint. Accidents like falls from heights or twisting or rolling one’s ankle while walking or running can potentially cause a fracture. Impact with an object, like during a car accident, can also cause the bones of the ankle to break.

Types and treatments of ankle fractures vary, depending on the nature and severity of the injury. Simple fractures in a single bone may not affect walking and other activities, while multiple fractures may require surgical repair. Pain, swelling, and bruising are generally immediate with an ankle fracture. In some cases, a broken ankle will appear visibly deformed.

What Causes Back of Ankle Pain When Walking?

The ankle is a complex collection of bones, cartilage, ligaments, and tendons. Damage or disease within these structures can cause ankle pain when walking and other symptoms. All of the conditions mentioned above can cause pain when you move and put weight on the ankle joint: arthritis, bursitis, sprains, strains, and fractures.

Physical Therapy for Pain on the Back of the Ankles

Pain at the back of the ankle can often be managed and reduced with nonsurgical treatment. Physical therapists provide a variety of techniques to reduce ankle pain, improve range of motion in the ankle and foot, and help prevent future injuries.

Treatment may include:

  • Taping
  • Stretches
  • Gait training
  • Dry needling
  • Manual therapy
  • Posture guidance
  • Therapeutic exercise
  • Strength and endurance training
  • Neuromuscular and balance training

Because some conditions require more invasive treatment, it important to consult your health care provider and schedule a physical therapy screening for an accurate diagnosis and custom treatment plan. Find a physical therapy clinic near you.

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