How To Manage An Achilles Tendon Injury
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Follow your doctors recommendations to get rest and manage pain and swelling.
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Choose alternative ways to be active.
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Try low-impact activities that do not place a lot of stress on your tendon, such as swimming or bicycling, rather than a high-impact exercise like running.
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Always let your doctor know if these strategies dont help reduce pain, swelling, and loss of function.
A Lateral Ankle Sprain/tear Could Be Causing Outer Ankle Pain
Ankle sprains are more commonly seen in athletes, but can occur in anyone. A lateral ankle sprain occurs when you twist your foot and ankle in an inwards direction. This can cause the 3 ligaments mentioned previously to become stretched out and weak.
The anterior talofibular ligament is the weakest and is the first one to become injured, followed by the calcaneofibular ligament, and lastly the posterior talofibular ligament.
Occasionally, tears of the ligaments can occur. If there is an injury to all three ligaments, complete instability of the ankle joint may occur.
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Posterior Achilles Tendon Bursitis
Early symptoms of posterior Achilles tendon bursitis may include redness, pain, and warmth at the back of the heel. Later, the top layer of skin may wear away. After several months, a bursa, which looks like a raised, red or flesh-colored area that is tender and soft, forms and becomes inflamed. If posterior Achilles tendon bursitis becomes chronic, the bursa may become hard and scarlike.
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The Most Uncommon Cause Of Heel Pain: Plantar Bone Spurs
Long-term, repetitive straining of the ligaments that connect your heel to your toes can cause a bone spur to develop on your heel. And actually, these bony growths form as your foot tries to heal itself.
Plantar bone spurs are relatively common about one in 10 people have one. But only 5% experience foot pain because of bone spurs. If you have heel pain, its more likely from another condition, like plantar fasciitis. Many people with plantar fasciitis have plantar bone spurs.
Other Causes Of Heel Pain
Less common causes of heel pain should be considered before a treatment regimen for plantar fasciitis is undertaken. These include sciatica, tarsal tunnel syndrome, entrapment of the lateral plantar nerve, rupture of the plantar fascia, calcaneal stress fracture and calcaneal apophysitis . Rarely, systemic disorders can cause heel pain.
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Pain On Outside Of Lower Leg Above Ankle At Night Other Causes
Leg pain can be a bother as it limits your ability to walk and run. It can make you feel incapacitated as you cant do the usual stuff.
If you have such symptoms, it would be wise to address the problem immediately.
The sooner you get treatment, the better, as such injuries and conditions will take time to heal.
Is Pain In The Back Of The Ankle Above The Heel Normal
Occasional soreness and tightness in the ankles can occur after physical activity, but ongoing and intense ankle pain are the signs of something more serious. Pain in the back of your ankle above the heel might not be normal if the pain is persistent and accompanied by other symptoms like swelling, sensitivity, grinding and clicking.
Take a look at the following conditions to become familiar with what might be causing pain in the back of your ankle above the heel, and find out what you can do to treat this pain.
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Upper Heel Pain Is A Common Complaint
Heel pain is one of the most common reasons for which patients are seen at the sports podiatrist, with upper heel pain constituting a large proportion of those cases. Upper heel pain can be frustrating and inconvenient, and if not diagnosed accurately and managed correctly, can lead to debilitating and chronic pain.
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Reasons Why You Might Have Pain In The Back Of Your Heel
When youre suffering from heel pain, location matters. That includes in the back of your heel!
Thats because heel pain is not just one problem, but can stem from a variety of different causes. There is often a big difference between what can cause pain along the bottom of the heel and what can cause pain in the back of it.
Different parts of the heel are connected to different other parts of the body, and are affected by different forces and activities. Knowing where exactly on your heel you are experiencing pain isnt picky its an important clue in making an accurate diagnosis!
No matter where or what kind of heel pain you may be experiencing, details matter. Thats why we always conduct a full examination and ask you questions about your condition. Never hesitate to let us know anything you might think is important to your case, because it often is.
So, what might pain in the back of the heel mean? There is more than one possible answer.
Are There Any Serious Concerns With Achilles Tendonitis
In most cases, Achilles tendonitis, while painful, is treatable at home or with minimal help from your foot and ankle specialist. Rarely, the tendon may thicken, and hardened nodules, or calcifications, may form where the tendon meets the heel bone. If this happens, the heel bone may become deformed and require invasive surgery to correct.
Be proactive about pursuing treatments for your Achilles tendonitis to avoid this unfortunate scenario.
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How Is Achilles Tendinitis Treated
Your provider will first recommend nonsurgical treatment. It may take a few months for the pain to get better especially if youve already had symptoms for a few months.
Nonsurgical treatment methods include:
RICE method:
- Rest: Stop doing activities that stress your tendon. Switch to low-impact activities, such as swimming, that put less stress on the Achilles tendon.
- Ice: Put ice on your tendon for up to 20 minutes, as needed throughout the day.
- Compression: Compress, or put pressure on, the tendon using an athletic wrap or surgical tape.
- Elevation: To reduce swelling, lie down and raise your foot on pillows so its above your heart.
Protect your tendon. Avoid walking up steep inclines or overstretching the tendon, such as by standing on a ladder rung. Wear:
- Supportive shoes, heel lifts or custom orthotics. Dont walk barefoot.
- Splint at night to help the Achilles tendon stay stretched while you sleep.
- Walking boot or walking cast if the pain is severe.
Other nonsurgical treatments that can help:
- Nonsteroidal anti-inflammatory drugs such as ibuprofen. Dont take the medication for more than one month without talking to your provider.
- Exercises you can do at home, such as calf stretches.
- Physical therapy, which uses strengthening exercises, massage, stretching and running re-education to help you feel better and regain your strength.
- Shockwave therapy, which uses strong sound waves to reduce pain and promote healing.
When Surgical Intervention Is Required For Pain On The Back Of The Heel
Because surgery for back of heel pain often results in a long recovery period, we try to exhaust all conservative treatment options before considering surgery. However, if all conservative treatment has failed, surgery may be indicated. Surgery for back of heel pain may involve:
- Removing the extra bone on the back of the heel.
- Removing the inflamed and thick retrocalcaneal bursa.
- Cleaning up the Achilles tendon where it attaches into the back of the heel. Sometimes, if the tendon is in bad shape, we must partially or completely detach the tendon and then reattach it.
- Removal of bone spur and reattachment of the Achilles tendon.
Surgery usually offers good outcomes, but has a long recovery. Initially, the leg must be immobilized to allow the surgical site to heal. Later, gentle range of motion exercises can be started. Usually there is very limited or no weight-bearing activity allowed for the first six weeks after surgery. Activity is gradually increased and significant improvement can take up to six to nine months. Surgical treatment can cause complications including increased risk of Achilles tendon rupture infection wound breakdown injury to nerves deep vein thrombosis pulmonary embolism and prolonged healing.
Medical References
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Common Causes Of Ankle Pain
If you are experiencing ankle pain, there is a good chance it may be due to one of these common causes.
Sprains
An ankle sprain is an injury of one or more ligaments . Ankle sprains may happen from stepping off a curb, walking on an uneven surface, falling, or playing a sport like tennis or basketball where a rapid change in direction causes the ankle to roll or twist inward.
Most commonly, ankle sprains happen in the anterior talofibular ligament , which is on the outside of the ankle. Symptoms include throbbing pain on the outside of the ankle, along with swelling, bruising, and/or a feeling that the joint may give out.
Medial sprains, involving the ligaments on the inside of the ankle, occur much less frequently. Medial ankle sprains cause throbbing pain on the inside of the ankle and result from the ankle rolling outward.
High ankle sprains are also unusual. They cause pain above the ankle, where ligaments connect the two lower leg bones. They are most common in people who play impact sports like hockey or football.
Tendonitis
Tendonitis occurs when the tendons, which attach muscle to bone, become irritated and inflamed. There are three types of tendonitis that can happen in the ankle: peroneal tedonitis, posterior tibial tendonitis, and Achilles tendonitis.
Peroneal tendonitis is inflammation of the peroneal longus or peroneal brevis tendons. These two tendons run along the outside of the ankle joint.
Arthritis
Anatomy Of The Outer Ankle
The ankle bones are made up of the tibia , the fibula, and the talus.
On the outside of the ankle, there are three major ankle ligaments:
Anterior talofibular ligament , the calcaneofibular ligament , and the posterior talofibular ligament .
These ankle ligaments stabilize your ankle and prevent your ankle from inverting.
The two tendons that course along the back of the fibula are called the peroneus longus and peroneus brevis tendons. These tendons help to evert and also help to stabilize the ankle.
The peroneus longus tendon inserts at the 1st metatarsal base and medial cuneiform bone. The peroneus brevis tendon inserts at the fifth metatarsal base.
The sinus tarsi is the tunnel of space between the talus and the calcaneus bone. It contains connective tissue, fat, and nerve endings. The sinus tarsi help provides stability to the ankle joint.
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What Other Possible Treatment Options Are There
Its possible you have some unique biomechanical problems that are contributing to your case of peroneal tendonitis. Or you may require a different set of exercises to get back on track.
If this is one of a number of injuries, your running form may be to blame.
Our running form course will analyze this for you, to make sure injuries become a rare occurrence, rather than it being rare you are healthy. One of the main reasons runners end up with injuries is because they are overstriding. Make sure you read up on our Overstriding, Cadence, And Heel Striking post for more on this.
Both Heckman et al. and Selmani, Gjata, and Gjika suggest getting custom orthotics to take stress off the peroneal tendons.7, 10
Unlike many other injuries, it does seem like there should be a difference between custom orthotics and standard over-the-counter inserts like SuperFeet or PowerStep.
Usually, the goal of an insert is to support the arch, which transfers stress to the outside of the foot.
This can be very helpful in injuries like Plantar Fasciitis or Shin Splints. But in the case of peroneal tendonitis, this could be a bad thing. Remember, over eighty percent of people who get peroneal tendonitis have high arches.
Building up arch support even more, and shifting stress to the outside of the foot , could actually make the problem worse!
If your case of peroneal tendonitis isnt responding to rest and physical therapy exercises, a custom orthotic might be worth a shot.
How To Treat Pain In The Back Of The Heel
As with any cause of heel pain in general, it is not always enough to simply identify the condition causing it. We must also understand and address the factors that are contributing to it.
We will always pursue conservative treatments whenever they have a reasonable chance of success and the vast majority of the time, they do. Parts of a conservative treatment plan may consist of, but are not limited to:
- Wearing better fitting or more accommodating footwear.
- The use of custom orthotics to shift excess forces away from vulnerable areas.
- Stretches and exercises designed to strengthen and condition the heels to prevent further damage.
- Non-steroidal anti-inflammatory drugs or other medications for relieving pain and swelling.
- Standard rest, icing, and recovery.
- Advanced treatments to accelerate healing of soft tissue injuries.
In more severe cases that do not respond well to conservative measures, surgery might become a consideration. This is very uncommon, however, and we will fully discuss all potential options with you.
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What Is Heel Bursitis
Bursae are small sacs of fluid around different bones and joints in your body. These sacs help cushion your joints and stop your bones from rubbing against each other. Bursitis happens when a bursa becomes irritated.
You have bursae in your heel near your Achilles tendon. Your Achilles tendon attaches your calf muscle to the back of your heel bone. Irritation to your bursae can cause different types of heel bursitis.
Retrocalcaneal bursitis. Your heel bone is called the calcaneus. Retrocalcaneal bursitis means inflammation in the bursa between your Achilles tendon and heel bone. This type is also called ankle bursitis or Achilles tendon bursitis.
Subcutaneous calcaneal bursa. Subcutaneous means under the skin, so this type of bursitis happens between the skin at your heel and your Achilles tendon. Itâs also called posterior Achilles tendon bursitis.
Achilles Tendon Pain: Symptoms Causes And Treatments
Understanding Achilles tendonitis, tendinosis, and tendon ruptures
Achilles tendon pain stems from the fact that, like all tendons, the Achilles tendon is strong, but not very flexible. The Achilles tendon connects muscles in your calf and lower leg to your heel bone, and it can only stretch so far. When it goes beyond its limits, it becomes inflamed or tears .
Stress or injury to the Achilles tendon can cause discomfort that can range from a slight ache and stiffness to severe Achilles tendon pain.
In this article, you’ll learn more about Achilles tendonitis, tendinosis, and rupture and how they can cause Achilles tendon pain. You’ll also leave this article knowing when to see a healthcare provider, how they will diagnose you, and how Achilles tendon pain can be treated.
Verywell / Alexandra Gordon
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Applying Kinesiology Tape To Your Foot
Before applying kinesiology tape to your foot, be sure to speak to your physical therapist to ensure that you are applying the tape properly and that kinesiology tape is safe for you to use. Your physical therapist can help determine if your specific condition with plantar fasciitis is likely to benefit from using kinesiology tape.
Some people with specific medical conditions should not use kinesiology tape, so consult your PT or doctor before attempting to treat your plantar fasciitis with taping.
To apply the tape to your foot, you may need a friend to help you, and you should review the different types of tape strips necessary to use kinesiology tape. Here is how you use kinesiology tape for plantar fasciitis:
Sometimes, an I strip can be used on the top of your foot to secure the ends of the lift strips so they do not peel away.
The kinesiology tape should be comfortable and should not be folded on the underside of your foot. You can keep the tape on for two to five days, and the tape can get wet. If it starts to peel away, simply remove the tape.
Physical Therapy For Pain In The Ankle And Heel
If you have been experiencing the pain in the back of your ankle and above your heel for a week or two now with no relief from at-home stretching, you should schedule an appointment with a physical therapist for more targeted treatment. Physical therapy is one of the most common treatments for Achilles tendinitis because it focuses on strengthening and stretching the damaged Achilles tendon, helping it to heal and reduce the inflammation that is responsible for your symptoms.
If your injury is related to a sport, your physical therapist may also recommend sports therapy to work with you on your form and movement to help prevent future injuries. Sports therapy also uses a treatment called Active Release Technique to massage around the damaged muscle in order to improve circulation, promote healing and improve functionality.
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