Heel pain and ankle pain usually appear separately. But sometimes, pain in the heel and ankle can occur together as a result of one injury or multiple, associated injuries.

Overuse

Runners and other athletes are especially prone to overuse injuries in the heel and ankle. Some, especially those with long legs, are also prone to having a stiff Achilles tendon and stiff calf muscles. As the foot and ankle literally hinge on these mechanisms, inflexibility leaves the tendon, heel and ankle at risk of injury, especially when we play sports. Usually, the injury appears in the form of Achilles tendonitis, calcaneal (heel bone) bursitis, or plantar fasciitis.

If, at the first sign of pain you rest, elevate and ice the sore area until the pain subsides, healing may be achieved without medical intervention. If you ignore the pain and keep training, the injury may become very serious. If pain continues for 4 days or more, see a podiatrist.

Stress fracture

A stress fracture in the ankle or foot generally occurs gradually from overuse. Depending on the location and severity of the fracture, pain can radiate through the entire foot, ankle and/or heel. The pain may be accompanied by numbness or tingling, redness, swelling and a feeling of instability.

It's essential that any fracture  - whether a small stress fracture or a more serious break - be treated by a podiatrist to insure that it heals correctly. Don't blow it off - ask anybody who's middle aged or older and they'll tell you how much these "minor" stress fractures come back to haunt you later in life.

Nerve conditions

Tarsal Tunnel Syndrome and peripheral neuropathy can cause considerable pain and discomfort. Tarsal Tunnel is an entrapment of the posterior tibial nerve which passes through your ankle. When the nerve becomes compressed, pain can be felt from the sole of the foot and throughout the ankle. Pain may also radiate to the leg and hip. Peripheral neuropathy, usually a side effect of diabetes, can cause tingling and pain at any point in the foot and lower leg.

Both conditions require the intervention of a podiatrist to relieve symptoms.

Tendinitis, Tendinosis, or tendon rupture

In or near the ankle, the Achilles tendon is the most likely tendon to cause pain. But pain may also be felt from injury to the peroneal, posterior tibial or flexor hallucis longus tendons. The area of swelling and tenderness usually indicates which tendon has been damaged.

Treat with rest, ice and anti inflammatories, and see a podiatrist for an evaluation.

Ankle Impingement Syndrome

Anterior Ankle Impingement or Posterior Ankle Impingement Syndrome occurs when soft tissues around the ankle become pinched. When the ankle is bent fully up or down, pain occurs. Runners, footballers and dancers are notorious for developing these syndromes.

Treat as above with tendinitis.

Ankle Sprain

An ankle sprain occurs when the ankle ligaments are subjected to an unnatural twisting, causing stretching or tearing of the ligaments.  A sprain can easily cause pain in the entire area around the ankle, including the heel.

Treatment by a podiatrist is necessary to insure that the sprain heals correctly. Damaged ligaments which are not cared for properly become weak and are more likely to be reinjured and cause long-term problems.

Osteoarthritis

Arthritis can occur in any joint in the body. It's especially debilitating when it takes up residence in the ankle. Due to the inflexibility of the arthritic ankle, arthritis patients are prone to plantar fasciitis.

Rheumatoid Arthritis

This chronic autoimmune disease attacks joints at any point in the body. RA usually starts in the small joints of the hands and feet, and progresses to the larger joints. More than 90% of Rheumatoid Arthritis patients develop symptoms in their feet and ankles, usually occurring in both feet simultaneously. Difficulty climbing stairs is an early sign that the ankle is beset with RA. Difficulty on uneven ground suggests that the hindfoot - the heel area - is showing signs of the disease. A podiatrist can identify your symptoms and you will be referred to a rheumatologist for treatment.