Posterior Ankle Pain

POSTERIOR IMPINGEMENT SYNDROME

This is a pinching of tissue behind the achilles tendon at the back of the ankle. Some people can have small bony fragments here called os trigonum.

These small bones usually attach to the talus bone in the ankle during childhood. However, in 10-15% of the population the bones remain separate. The small bones can also separate with an ankle fracture.

The os trigonum do not always cause pain. However, they can get caught in the joint and cause pain with ankle movement. When they get irritated with overuse or trauma, it is known as os trigonum syndrome.

The most painful movement is being up on your toes. This is common with ballet pointe shoes, cricket fast bowlers, running down hills, or with ankle sprains. This creates compression in the back of the ankle joint.

SYMPTOMS:

• Pain between achilles tendon and the outside of the ankle
• Pain when on your feet
• Stiffness, weakness, swelling in the back of the ankle
• Unable to fully point your toes
• Bony prominence you can feel at the back of the ankle

PHYSIOTHERAPY TREATMENTS MAY INVOLVE:

• RICE
• Individualised strength, flexibility, and, balance exercises
• Correcting faulty biomechanics
• Soft tissue techniques
• Referral to medical doctor or for medical imaging

OSTEOCHONDRITIS DESSICANS

Osteochondritis dessicans in the ankle involves the talus bone. A lesion can develop on the top of the talus which may cause a small piece of bone to separate from the talus. This is known as osteochondritis dessicans.

This occurs due to small, repetitive traumas or a large trauma to the area. This condition develops between age 10-20 years, but you may not have symptoms until later in life.

SYMPTOMS:

• Pain when on your feet
• Joint swelling
• Instability or locking in the ankle

PHYSIOTHERAPY TREATMENTS MAY INVOLVE:

• Limiting movement in the area
• RICE
• Individualised strength, flexibility, and balance exercises
• Correcting faulty biomechanics
• Joint mobilisation
• Soft tissue techniques

SEVER’S DISEASE

This is a common cause of heel pain in children and adolescents 7-15 years old. It occurs during growth spurts in children who are very active with running and jumping activities. These activities lead to small injuries where the calf muscle tendon attaches to the heel bone. This is near the growth plate of the heel.

This condition can last 6-24 months, but can be eased with physiotherapy treatment.

SYMPTOMS:

• Limping
• Pain during or after activity, resolves with rest
• Pain at the back of the heel
• Stiffness
• Tenderness
• Swelling

PHYSIOTHERAPY TREATMENTS MAY INVOLVE:

• Activity modification
• Examining sport shoes
• Ice
• Individualised strength and flexibility program
• Manual techniques

ACHILLES TENDON RUPTURE

The achilles tendon is a strong band of fibres that attaches the calf muscles to the heel bone. It is the strongest tendon in the human body, and it is also the most commonly ruptured, or torn, tendon (Maffulli, Longo, Gougoulias, & Denaro; 2008).

Rupture is usually caused by a strong contraction of the calf, such as quickly going up on your toes or falling from a large height. A rupture of the achilles tendon is a tear involving 50% or more of the muscle fibres in the tendon (Grade 3).

How does a Human Achilles Tendon Rupture …? Here’s how … check it out @MayoClinic Materials & Structural Testing Core @mayoclinicsport ! pic.twitter.com/qM9ZoXJ2Oq

— Tim Hewett (@Hewett1Tim)September 22, 2017

SYMPTOMS:

• Sudden snap in the lower calf
• Loud crack or pop sound
• Severe pain often described as being stabbed in the heel with a knife
• Swelling at the back of the heel
• Unable to point toes
• Limited walking ability

PHYSIOTHERAPY TREATMENTS MAY INVOLVE:

• Possible surgery or conservative management
• RICE
• Individualised range of motion, strength, flexibility, and balance exercises
• Activity modification
• Examining biomechanics in the legs, ankles, and feet