What Causes Ankle Pain? Top Ankle Pain Causes, Including Posterior Tibial Tendonitis
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Ankle pain is common, but understanding the exact root cause of your ankle pain can be tricky. It's because the ankle is a complex joint. Various components must work together, including bones, tendons, muscles, nerves, and ligaments, for the ankle to function properly.
Let's look at the top six causes of ankle pain, with a special focus on Posterior Tibial Tendonitis (PTTD). Identifying the cause of your ankle pain the first step toward effectively managing it, so that you can keep doing what you love to do.
Several components make up the ankle joint. The primary bones include the tibia, fibula, and talus. They form a stable yet flexible structure that lets you move, and supports your body weight.
Tendons such as the Achilles tendon and the posterior tibial tendon are crucial for movement and stability. These tendons connect muscles to bones, enabling the foot to function properly. Various muscles, including the calf muscles, support the ankle, as well as the foot, as you stand, walk, or run.
Nerves, such as the tibial nerve, play vital roles in sensation and movement. The nerves pass signals to and from brain, which ultimately controls the joint functions. Lastly, ligaments are the tissue that connects bones to each other. Ligaments provide stability to the joint and prevent excessive movements that could lead to injuries.
All these components must work together for the ankle to work, and weakness or imbalance in any can lead to ankle pain.
Any good doctor or a physical therapist will tell you that effective treatment of ankle pain begins with identifying the underlying cause. Different root causes require different treatment approaches, so understanding what is causing your pain is crucial.
When there isn't an obvious injury like a sports injury or ankle sprain, these six conditions are at the top of the suspect list:
Posterior Tibial Tendonitis affects the posterior tibial tendon (also called the tibialis posterior tendon) that attaches a calf muscle to the arch in your foot. Its main function is to maintain the healthy spring of the arch.
Usually, overuse and resulting inflammation or tissue damage are what causes ankle pain in Posterior Tibial Tendonitis (or Posterior Tibial Tendon Dysfunction, PTTD).
Symptom checker:
With PTTD, the pain typically feels like a low-grade ache inside the ankle, sometimes a burning sensation. You may feel the pain below or above the ankle. You may also have pain in the arch of your foot, because the weakened tendon can't maintain the healthy shape of the arch.
Achilles Tendonitis involves inflammation of the Achilles tendon.
Symptom checker:
The pain typically feels like a dull ache during and after activities. You may feel the pain in the heel or at the back of the leg. Ankle pain from Achilles Tendonitis is usually felt along the affected tendon.
As the condition worsens, the mild, dull ache can change to a sharp pain. Swelling in the heel or in the ankle, along the Achilles tendon may also be present.
Bursitis is the inflammation of the bursae, small fluid-filled sacs that cushion the joints.
Symptom checker:
The pain with bursitis in the ankle is typically felt in the back of the ankle and heel, along with pressure and tightness. The pain can radiate from the ankle to the heel and is often triggered by pressing on the affected heel.
Tarsal Tunnel Syndrome occurs when the tibial nerve is compressed in the narrow passageway inside the ankle. Its mechanisms are similar to its better-known cousin, the Carpal Tunnel Syndrome.
Symptom checker:
Ankle pain from Tarsal Tunnel Syndrome, since it's a nerve condition, is similar to other nerve pain conditions. It includes shooting pain, burning sensation, tingling, and numbness inside the ankle - and sometimes on the bottom of the foot.
There are multiple systemic conditions that affect multiple joints throughout the body, such as Rheumatoid Arthritis and Lupus. These systemic conditions can also affect the ankle joint, causing pain in the ankle.
Both high arches and flat feet (low arches) can predispose you to ankle pain. Depending on the specific anatomical feature, pain can vary and impact the overall structure and function of the ankle.
You may be wondering if Plantar Fasciitis can cause ankle pain - and the answer is yes. Although Plantar Fasciitis pain is usually felt in the bottom of your foot, typically in the arch or the heel, in physical therapy offices, some people with Plantar Fasciitis also report ankle pain.
This can be because some people develop both Plantar Fasciitis and Posterior Tibial Tendonitis, which causes ankle pain. Ankle pain can also develop when you modify your posture or gait to reduce Plantar Fasciitis pain, and that leads to imbalance or malalignment in the rest of your kinetic chain.
Posterior Tibial Tendonitis, also known as Posterior Tibial Tendon Dysfunction (PTTD), is a common cause of ankle pain. According to studies, 3-10% of people, depending on age and sex, develop PTTD. Here's Luke's 101 on what Posterior Tibial Tendonitis is.
Differentiating PTTD from other conditions
It can be particularly challenging to distinguish between PTTD and other conditions such as Plantar Fasciitis, especially if you also experience pain in the arch of your foot. However, it's worth spending some time to identify what's causing the ankle pain. That's the first step toward finding the most effective treatment for the condition.
Figuring out if you have Posterior Tibial Tendonitis can be tricky even for podiatrists and physical therapists, but here are some clues to see if your foot or ankle pain is from PTTD:
Recognizing the symptoms of PTTD early is key to finding the right treatment and avoiding progression of the condition. If you are seeking a healthcare professional's help, being extra-aware of these telltale symptoms can help your provider diagnose your ankle pain properly.
Look out for these three telltale signs:
The right treatment and lasting pain relief specifically address the root cause. That's why our at- home physical therapy solutions are condition-specific. Generic recovery tools can give you temporary relief, but they aren't effective enough to get you to full recovery.
The gold standard of non-invasive, active treatment for Posterior Tibial Tendonitis incorporates four components that work together:
This is the basis of the Alleviate Method, developed to bring the effective treatment methodology and tools to everyone's home. Our PTTD System uses the Alleviate Method to get you back to doing what you love, without a visit to a doctor's office. From the palm of your hand, Luke, our co-founder and a seasoned physical therapist, will guide you all the way to full recovery.
Main Causes of Ankle Pain: Conditions like Posterior Tibial Tendonitis (PTTD), Achilles Tendonitis, Bursitis, Tarsal Tunnel Syndrome, systemic conditions, and anatomical characteristics can cause ankle pain without an obvious injury.
Posterior Tibial Tendonitis (PTTD): This condition involves inflammation and micro-tears of the posterior tibial tendon, causing pain inside the ankle and sometimes affecting the arch of the foot.
Symptoms: PTTD pain often feels like a dull ache inside of your ankle, or a burning sensation. It usually gets worse after activity, and going uphill or up stairs feels worse than walking on a flat surface. You might have swelling around the ankle, too.
Foot and Ankle Pain Treatment: Physical therapists use a four-pronged approach to treat Posterior Tibial Tendonitis. Alleviate PTTD System replicates this gold standard of PT treatment with a support brace, medical-grade compression socks, a PTTD exercise program, and a deep tissue foot massager.
Luke Ferdinands, Physical Therapist & Co-Founder
A New Zealand-trained physical therapist with over 20 years of experience, Luke developed the Alleviate Method to bring the gold standard of physical therapy care to everyone's home. Luke leads the development of physical tools and digital physical therapy content, focusing on driving clinical outcomes for people with chronic musculoskeletal pain conditions like Tennis Elbow, Plantar Fasciitis, Runner's Knee, and more.
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