Pain At The Back Of The Ankle. It’s Not Alwa
Posterior ankle pain refers to discomfort or pain through the back of the ankle. This is often used as an umbrella term given the numerous amounts of anatomical structures around the posterior ankle. We have a blog here where we discuss Achilles tendon pain which is a very common cause of posterior ankle pain. The aim of this blog will highlight differentials to Achilles tendinopathy and give examples of which population group typically suffers from these injuries.
Pain at the back of the ankle is a common presentation at Foot & Ankle Podiatry Clinic Albury.
Bursa
Bursae’s are fluid filled sacs that lie within joints and soft tissue structures. Their aim is to reduce friction and aid with cushion to the surrounding structures. There are two bursae’s that lie within the posterior ankle which can cause pain when inflamed.
Retrocalcaneal bursitis: Located between the achilles tendon and calcaneus. Often described as enthesopathy and caused from a combination of compressive and tensile loads. Often seen in runners due to the repetitive combination of loads.
Superficial subcutaneous bursitis: Located between the skin and achilles insertion. This injury is more so caused from external friction as appose to mechanical load. Often provoked from tight fitting shoes through the heel counter which can irritate the site.
Kager’s fat pad syndrome
The kager’s fat pad is a small fatty tissue that lies between the achilles tendon and tibia and found above the retrocalcaneal bursae. This syndrome refers to an inflamed fat pad and is typically caused from a combination of compressive and tensile loads, similar to retrocalcaneal bursitis. Therefore, runners and endurance athletes are mostly affected.
Os Trigonum
Represents the failed fusion of the posterolateral talar tubercle which often looks like an extra bone in the back of the ankle/subtalar joint. Can lead to an entrapment or cause swelling in the cartilage. This is most commonly seen in 8-13 years old cricket bowlers and/or ballet dancers because of their high energy plantar flexion movements.
Flexor hallucis tenosynovitis
Demonstrate inflammation of the flexor hallucis tendon sheath that is caused from plantarflexion and eccentric dorsiflexion overuse, weak calf muscles and a stiff big toe joint. Again, most commonly seen in ballet dancers because of the amount of plantarflexion/dorsiflexion repetitions.
Subtalar/ankle joint synovitis
Displays inflamed synovial fluid through either the subtalar or ankle joint by combing side to side movements with rapid plantarflexion. A perfect example of someone who is at higher risk would be an AFL footballer because they are heavily agility based with lots of ball kicking.
If you are wanting a thorough assessment and advice on the posterior ankle as a whole, coming into our Foot & Ankle Albury Podiatry Clinic.
Written by Cooper Garoni.