Ankle tendon pain

Do you have ankle tendon pain?

There are two main types of ankle tendon problems:

Achilles tendon tibialis
posterior tendon

These problems can take a long time to resolve, it can be painful with rest and less painful with activity.

Achilles tendon problems

The Achilles Tendon connects the large calf muscle to the heel bone. It allows you to point your toes and is particularly important in walking and climbing stairs.

Symptoms:

Pain directly over the Achilles, tender to touch.
Pain and stiffness on waking, which improves with movement.
Pain on walking, running or stairs.
Pain after activity.

If you have been wearing shoes with poor cushioning, with poor arch support.
If you are overweight – this will put extra strain on your heel if there is an overuse or stretching of your sole e.g. athletes who increase running intensity or distances.
If you have a tight Achilles tendon.

Tibialis posterior tendon problems

The Tibialis Posterior is located in the lower leg. The tendon passes down the back of the leg, inside the ankle and under the foot. It is particularly important in walking to maintain the arch of the foot and stop us from getting “flat feet.”

Symptoms:

Pain anywhere tracking the tendon from behind the inner ankle bone to inner aspect of the foot just above the arch.
Pain replicated on single stance heel lift.
Pain worsens with activity involving repeated flexion of foot.

Top tips

Read our top tips for improving ankle tendon pain.

Try an ice pack on the tendon for 10 minutes (wrap it in a damp towel to avoid an ice burn). This can be done regularly for the duration of the pain.
Take pain relief recommended from your GP.
Consider insoles to support the arch of your foot.
Wear appropriate supportive footwear with good arch support that is secure around the heel.
Activity modification, regular gentle activity can help to ease the pain. Avoid excessive repetitive stress such as running.

Do not use ice on your ankle if you have poor sensation over the area, an infected wound, Raynauds Syndrome or Cryoglobulinaemia.

How much pain is too much pain?

Before exercising

Before exercising, rate your pain at the moment on a scale of 0 to 10, where 0 is no pain and 10 is the worst pain you can imagine.

A maximum pain level

A maximum pain level of 4/10 whilst exercising is fine as long as it eases within 45 minutes of the session and does not interfere with sleep or activities the next day.

If your pain increases

If your pain increases beyond this, simplify the exercise by reducing the range of movement or number of repetitions, or try an easier exercise.

Exercise programme

Please complete exercises A and B everyday for the next 12 weeks, alongside Phase 1.

Everyday exercises

A) Pushing toes into wall

Long sitting with arm support. Feet resting against a wall.
Push your toes into the wall, as if to try and push the wall away. Feel the muscles of your calf tightening. Hold for approximately 10 seconds.
Repeat 10 times.

B) Pushing inside of feet together

Sit on a chair or on the floor. Put the inner borders of your big toes together.
Press the inner borders of your big toes together.
Hold for approximately 10 seconds.
Repeat 10 times

Continue with activities of daily life and exercising, as long as the pain whilst doing these activities, is only mild to moderate. It may be helpful in this phase to ice the tendon for 20 minutes, once a day.

Anti-inflammatory medication may also be helpful at this time, please speak to your pharmacist.

The amount of repetitions should be guided by your pain. As long as the pain is mild to moderate, you are fine to keep exercising (it is not harmful to your tendon).

Phase 1

A) Two footed heel raise

Start by doing as many reps as your symptoms will allow - with a maximum of 15 reps. Repeat 3 times.
Stand with both feet on the floor. Raise onto your toes.
Let your heels drop downwards.
Push up on your toes and slowly lower back down.
Complete exercises once per day.

B) Two footed heel raise with lowering on affected foot

Start by doing as many reps as your symptoms will allow - with a maximum of 10 reps.
Standing with both feet on the floor, push up on your toes. Shift your weight to your affected leg, taking your good leg off the floor. Slowly lower back down to the floor.
Repeat once a day.

C) Single foot heel raise

Start by doing as many reps as your symptoms will allow - with a maximum of 10 reps.
Stand on one leg.
Push up on your toes and slowly lower.
Repeat once a day.

D) Seated calf raise with weight

Start by doing as many reps as your symptoms will allow - with a maximum of 10 reps.
Sit with both feet on the floor. Place a light weight (13kg) on your legs. Slowly raise up onto your toes and then return to the floor. (If you do not have weights books or a back pack filled with water bottles can be used as a substitute)
Repeat once a day.

Once you have completed for two weeks move onto Phase 2 (you no longer need to complete exercises in Phase 1.

Phase 2 (weeks 2 to 5)

A) Two footed heel raise on step

Start by doing as many reps as your symptoms will allow - with a maximum of 15 reps. Repeat 3 times.
Stand on both feet on a step with both of your heels over the edge. Let your heels drop downwards.
Push up on your toes and slowly lower back down.
Complete once per day.

B) Single foot heel raise on step

Start by doing as many reps as your symptoms will allow - with a maximum of 15 reps. Repeat 3 times.
Stand on one leg on a step with your heel over the edge. Let your heel drop downwards.
Push up on your toes.
Complete once per day.

C) Seated single leg calf raise with weight

Start by doing as many reps as your symptoms will allow - with a maximum of 15 reps. Repeat 3 times.
Sit with your heel of your affected leg over the edge of a step. Place a light weight (1-3kg) on your leg. Raise up onto your toes and slowly lower.
Complete once per day.

Once you have completed for 3 weeks please move onto Phase 3.

Phase 3 (weeks 6 to 12)

Continue with exercises in Phase 2.

Progress exercises by slowly adding weight, (this can be done by wearing a back pack with bottles of water in it).
For seated calf raises the back pack can be placed on your knees.
As with previous levels, let your pain guide you.

If your symptoms are still causing your problems, please call the Physio Advice Line on 0300 555 0210.

Need more help?

Consider self referring using the link below:

If you have a new injury or problem, please look at the self help information in our advice pages. We will often complete the same exercises and share information in clinic appointments.

If you still need some more help you can self refer into our service. Please note that the NHS is currently experiencing longer than normal waits, for more information visit our waiting times page.

Refer yourself to physiotherapy