Common Running Injuries: Pain in the Ankle or Back of the Heel

Below are descriptions of common running injuries to the back of the heel or ankle. In the case of overuse injuries such as Achilles tendonitis and retrocalcaneal bursitis, the pain may be mild at first and gradually get worse.

Achilles tendonitis
Symptoms of Achilles tendonitis can include pain, skin redness, and swelling just above the heel. The area may also become stiff, limiting the ankle’s range of motion.

The Achilles tendon connects the calf muscles to the back of the heel bone, called the calcaneus. If the tendon becomes irritated and inflamed it is called tendonitis.

Though it can affect athletes and non-athletes alike, Achilles tendonitis frequently occurs in runners who ramp up their training too quickly or whose calf muscles are too tight. Symptoms may be worse first thing in the morning or after a workout.

Rest and other non-surgical treatments can usually relieve symptoms. However, blood flow is limited in this area of the body, so Achilles tendonitis can be slow to heal.

Heel (retrocalcaneal) bursitis
Pain, tenderness, and swelling at the back of the heel can indicate inflammation of the retrocalcaneal bursa. This bursa is a small, fluid-filled sac that serves as a both a cushion and lubricant between the heel bone and the Achilles tendon. It can become irritated and inflamed from excessive walking, jumping, or running.

Read more about Heel (Retrocalcaneal and Retroachilles) Bursitis on Arthrtis-health

Running uphill, which causes the foot to flex considerably, can be especially irritating to a retrocalcaneal bursa.

Because the symptoms are similar, heel bursitis and Achilles tendonitis are often mistaken for one another. Moreover, a person can have both conditions at the same time. For example, if it is left untreated, Achilles tendonitis can bring about retrocalcaneal bursitis.

Ankle sprain
An ankle sprain is not an overuse injury but a one-time traumatic injury that occurs when a ligament that connects two bones in the ankle joint is stretched or torn. A runner may sprain an ankle by landing wrong (for example, "rolling the ankle") or during a fall. The pain of a sprain is immediate and is typically accompanied by ankle swelling. The person may not be able to put weight on the affected foot.

See All About Ankle Sprains and Strains

Initial treatment usually involves R.I.C.E: Rest, Ice, Compression, and Elevation. A patient may need to use crutches and gradually return to weight bearing on the ankle before resuming a workout routine.

See The P.R.I.C.E. Protocol Principles

As with most injuries, these conditions are easier to treat in the early stages. If pain in the ankle or back of the heel does not resolve after two or three weeks of rest, or if pain is severe, medical attention is warranted. Runners can make an appointment with a primary care physician, physiatrist, podiatrist or orthopedist for a diagnosis and treatment plan.

See The 2 Common Types of Heel Spurs