Ankle pain: front and back


Anterior ankle pain

If the pain occurs at the front of the ankle or foot instep, there could be an injury to the joint surface or an anterior impingement syndrome.
Lesions of the articular surface can affect only the cartilage layer or cartilage and bones (osteochondral).
It can happen that you want to shoot a ball, but the foot accidentally hits the ground.
This can result in a stretching of the ankle ligaments at the level of the foot instep, a subluxation of the ankle bone or a bruise with swelling of the ankle and foot.

Anterior impingement at the ankle joint

The cause of anterior bone spurs is unknown, but they are most likely the result of recurrence trauma.
Anterior impingement by bone spurs is relatively common in athletes, especially in football. Rugby and basketball players.

There is a restriction of movement of the ankle joint.

The pain is stronger when running up, climbing stairs and tiptoe in a squatting position, because in these positions a dorsiflexion of the foot takes place.

If the impingement syndrome exists on the inside of the ankle, the pain occurs inside.

Anterior pain on the shin

If the pain occurs at the bottom of the shin, there are different causes.
Symptoms of the various diseases include pain and inflammation in the lower third of the shin.
Periostitis is the inflammation of the periosteum; by far the most common is the shin.
The symptoms are pain when stepping and walking, in severe cases they are persistent and make themselves felt even at night, but the foot does not swell.

Rarer lesions
A lesion of the shin-fibula joint means a tear of the connective tissue that holds the tibia and fibula together and lies just above the ankle joint; it usually occurs in conjunction with other major ankle injuries.
Symptoms include severe pain in the ankle, impaired functionality and numbness when palpating; in addition, the ankle and foot swell due to the accumulation of inflammatory fluid or blood (bruising).
The inflammation of the tissue structures also causes restriction of movement and limping.

Posterior ankle pain

Pain in the back of the ankle is relatively common and can be caused by inflammation of the tendons (tendinitis), bursa (bursitis), bone fractures or circulatory problems.

Achilles tendonitis is caused by excessive strain and causes pain and inflammation at the back of the ankle.
Typical symptoms include: redness and thickening of the Achilles tendon, limited mobility with dorsiflexion of the foot, pain when palpation and stretching of the tendon, discomfort with contraction of the calf muscles.
In more severe cases, the pain also occurs when cycling.
Tendopathy of the Achilles tendon also includes degeneration of the tendon (tendinosis) and inflammation of the tendon-enveloping tendon sheath (tendovaginitis).

Over time, Achilles tendonitis can cause painful calcium deposits to form at the tendon base on the heel.
The degeneration of the tendon can – even without a severe strain – result in partial or complete rupture of the Achilles tendon.

The treatment of Achilles tendonitis includes a rehabilitation program with laser therapy, Kinesio taping, sports massages, as well as stretching and strengthening exercises.



The bursa is a small, fluid-filled sac that lies within a joint between the tendon and bone. It should lubricate the tendon and allow a smooth movement.
Bursitis is the inflammation of the bursa, the amount of fluid in which increases and causes pain.
Bursitis of the Achilles tendon causes swelling in the posterior, outer area of the ankle.
This disorder is called bursitis calcanea.
The pain is felt when walking, because the heel rubs against the shoes; it is even worse when running, because there is an increased irritation here.

Haglund’s syndrome (Haglund’s heel) is a deformity of the heel bone, a visible outgrowth of bone at the back of the heel.
The constant rubbing movement of the edge of the shoe can put the bursa on the heel in a state of irritation and cause bursitis.

Heel bone fractures have an extremely limiting effect, because they make the appearance of the foot impossible.
They often occur in accidents with high energy expenditure, such as a fall from a great height or a car accident. For this reason, fractures of the heel bone are often serious and can cause long-term problems.
Typical signs and symptoms:

  • Ache
  • bruising,
  • Swelling
  • deformation of the heel,
  • The foot and heel cannot be loaded.

With minor fractures of the heel bone, the pain is usually not so severe that it makes walking impossible, usually the patient limps.
This happens because the Achilles tendon exerts force on the heel bone as it walks to support body weight.
If the heel bone is deformed due to an injury, the muscle and tendon cannot generate enough energy to withstand body weight. The foot and heel feel unstable. Conservative treatment
If the fragments of the bone have not shifted during the injury, surgery is not necessarily necessary.
The foot is immobilized by a bandage or similar, so that the bone ends are kept in the correct position during the healing process.
Surgical treatment

If the ends of the bones have shifted (dislocated fracture), surgical intervention may be necessary.

Diffuse pain

Arthritis is not a common cause of ankle pain, the ankle joint is affected much less often than other joints.
However, the cartilage layer of the ankle joint can wear out, which is often extremely painful. Ankle inflammation is more common in patients with goutrheumatoid arthritis or psoriatic arthritis and occurs less frequently than osteoarthritis.
Damage to the ankle joint is rare; in Italy, thousands of artificial knee and hip joints are used every year, while the number for ankle prostheses is less than a hundred.

Rheumatoid arthritis is an autoimmune disease that causes the chronic inflammation and pain of many joints.
Gout is a form of arthritis characterized by a high concentration of uric acid deposited in the joints.
Treatment consists of anti-inflammatory drugs or heat therapy.

The following forms of arthritis can cause ankle pain:

Damage to articular cartilage can occur as a result of a sprained ankle, fracture, or other significant injury trauma.
Cartilage damage can be confined to a smaller region or cause diffuse arthritis.

Pot fracture

The fracture of one or both bone protrusions on the ankle (inner and outer ankles) is usually caused by a traumatic injury, such as a fall from a greater height or a sprain.
Symptoms include pain (especially when it occurs), swelling, sometimes deformity, and numbness when pressing on the injured area.
A bone fracture is diagnosed on the basis of an X-ray, rarely a CT or magnetic resonance is performed.

Diagnosis of bone pain

The diagnosis is made by a doctor; however, there are some typical characteristics that may indicate the cause of foot problems.

Does the pain occur suddenly, do clothes or pajamas cause pain when rubbing against the joint?

Possible cause: gout (inflammation caused by an increased level of uric acid in the blood).

Does a fever occur or is the joint swollen and reddened?
Fever associated with joint pain and swelling can be caused by infection of the joint. If several joints are affected, it may be rheumatic fever.

Is the ankle swollen and a bruise visible, but the leg can still be loaded?
There may be a sprain of the ankle or a small fibula fracture.

Are the pain and swelling so severe that the leg cannot be loaded?
A bone fracture or a severe sprain is possible.

Is the ankle swollen, stiff (especially when getting up in the morning, for at least an hour) or is there irregular pain in both feet?
It may be rheumatoid arthritis.

Do the symptoms occur before or during weather changes, signs and symptoms are: swelling, stiffness and pain that increase with movement of the ankle?
These symptoms could be caused by osteoarthritis, a degenerative joint disease, or by old injuries/fractures of the ankle.

Is the pain persistent and very intense or stabbing without injury?
If the ankle hurts throughout the day and also at night, there could be inflammation of the nerves.

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