Rearfoot and Ankle Pain

Rearfoot and ankle pain is a common problem. There are several problems that may lead to pain in the rearfoot, including biomechanical causes (flatfoot, high arch feet, impingement, etc), arthritis, tendinitis, neuritis (tarsal tunnel syndrome), injuries (fractures and sprains), and multiple other problems.

Posterior tibial tendon pathology

The most common tendon problem in the rearfoot is posterior tibial tendon pathology. The posterior tibial tendon is the main tendon to hold up the arch. The tendon can develop problems due to overuse, flatfoot, injury, tight calf muscles, and other causes. The pain may be on the inside of the ankle or at the point in the arch where the tendon inserts. It is typically achy or sharp pain, increasing with weight bearing and activity. Treatment is aimed at reducing the stress of the tendon. This may include immobilization, arch supports, stretching exercises, physical therapy, and anti-inflammatory measures. If conservative treatment fails, there are multiple surgical options based upon the cause of the pain and pathology. This may include muscle lengthening, tendon repair, surgery on the bones, etc.


Another common cause of rearfoot/ankle pain is arthritis. This may develop and progress due to flat feet, tendon problems, or injuries. The symptoms are typically sharp or achy pain which increases throughout the day (especially with weight bearing), stiffness, and swelling. The aim of treatment includes reducing the stress on the joint and reducing the inflammation. Treatment may include activity modification, arch supports, shoe gear modification, injections, and anti-inflammatory measures. If conservative treatment fails to reduce the pain, surgical treatment may be recommended. This may include arthroscopy or fusions.

Tarsal tunnel syndrome

Tarsal tunnel syndrome occurs when there is an impingement of the nerve in the inside of the ankle. The pain may be described as shooting pain, numbness, or burning. Treatment options may include arch supports, anti-inflammatory measures, or injections. Surgical treatment typically requires releasing the ligaments or structures which cause the impingement onto the nerve.


Trauma may lead to fractures, sprains, or tendon ruptures in the rearfoot and ankle. Early diagnosis may be crucial for proper treatment and optimal function in the future. Refer to the trauma section for more information.

There are many other conditions which may cause rearfoot and ankle pain. If you’re dealing with any recurring pain in the rearfoot or ankle, schedule an appointment with us so that we can diagnose the problem and help you on your way to recovery.