Ankle pain after running is tricky because the cause is widely varied from very benign issues to those requiring medical solutions. Which of course makes it difficult to figure out what your next course of action should be.
Should you stop running? Run shorter distances? Take days off? Go to the doctor?
If you know some of the common causes and solutions for ankle pain from running, then you’re at least taking some steps in the right direction when it comes to running ankle-injury-free!
Today we’re going to explore why this is such a frequent running issue, the most common causes of ankle pain while running and how to begin treating them once you find the cause.
Why Does My Ankle Hurt When I Run?
The short answer to this is that your ankles are being used with every step when running.
They’re connected to your feet, which are pounding the ground over and over and over again as you run. With each stride, your ankles are designed to help with impact absorption, propel you forward and help your foot maintain proper alignment.
In fact, when you’re lacking full dorsiflexion (range of motion) in the ankles, your knees then have to absorb more of the force while running.
That’s a lot to ask of these tiny muscles being used for long distances. Without the right strength and mobility, it’s not uncommon for your ankles to hurt when you run.
Sometimes your ankles might not hurt until after running, but the basic root cause of many ankle injuries is still the same: overuse of your ankle.
Sharp ankle pain when running is always a sign to stop. This applies to any injury. Stop, see a doctor, get a diagnosis.
Why do my ankles hurt from running?
As you’ll see below there are a few overwhelmingly common reasons!
- Adding too much mileage before your body is ready
- Increasing the amount of speed work before your body is ready
- Running in poor fitting shoes (not enough stability or worn out)
- Previous injuries (once you’ve sprained an ankle it’s more likely to happen again)
- Weak muscles or muscle imbalances
- Lack of ankle mobility
Now let’s look more at how to stop ankle pain when running by understanding the common causes.
9 Common Causes of Ankle Pain
Overuse of your ankle muscles while running, in general, will cause most of the most common ankle injuries. But what exactly is wrong with your ankle that is putting you through such pain?
Here are some common injuries that cause ankle pain in runners, and solutions for those injuries.
1. Ankle Stress Fractures
An ankle stress fracture is constituted of tiny breaks or cracks in the bone of your ankle. It feels like what is commonly referred to as “shin splints.” Basically, you’ll feel a sharp pain in your ankle.
No matter which bone a stress fracture occurs in, it’s a serious injury that cannot be ignored. Stress fractures, unfortunately really put a damper on your running.
Cause of an Ankle Stress Fracture
What causes such a scary-sounding injury? The bottom line is the repetition of a motion, which is exactly what we do in running. Your muscles can’t always absorb the shock from the repeated pounding of your feet.
The longer the distance you run, the more likely you are to develop a stress fracture in your ankle. Particularly if you have increased your mileage too quickly.
Additionally, athletes that are under fueled are more likely to develop stress fractures.
Solutions to an Ankle Stress Fracture
If you feel like the ankle pain you’re experiencing could be a stress fracture, have an orthopedist examine the exact area of pain. He or she may order an x-ray if a simple examination doesn’t yield enough information.
It’s not unheard of for something that feels like an ankle stress fracture to go away on its own, but it won’t happen without at least a short break in your running.
👉 Check out this guide to coming back to running after a stress fracture once you’ve healed.
2. Ankle Sprain or Strain
A sprained or strained ankle is usually associated with a fall or misstep while walking or playing some kind of sport where jumping occurs. While often from quick turn sports like basketball or volleyball, ankle sprains and strains can happen to runners as well.
Usually there will be some swelling and tenderness around the ankle. The more severe (a sprain) will be more swollen, bruised and difficult to walk.
An ankle sprain means the muscle is overstretched or torn. A strain means the ligaments tear or become overstretched.
Cause of an Ankle Sprain or Strain
Ankle sprains and strains are not usually caused by overuse of the ankle, as many of the other ankle injuries are.
Often sprains or strains occur from one incident where you step wrong or roll your ankle. It’s jumping down from the curb, it’s hitting a rock wrong on the trail, it’s just a bad step.
You’ll feel the pain almost immediately.
Solutions to an Ankle Sprain or Strain
The silver lining for ankle sprains and strains is that they are usually easy to self-diagnose, and treat.
The best treatment is the RICE method –Rest, Ice, Compression, Elevate. So rest your ankle, apply ice and compression, and put your feet up!
This will help alleviate the pain and swelling in your ankle and help you get back to normal as quickly as possible.
👉Just remember ice is only to dull the pain, then we move on to heat! Understand ice vs heat for healing.
3. Posterior Tibial Tendonitis
The ankle pain from posterior tibial tendonitis is something that can occur readily in runners because of the high-impact nature of the sport. This type of ankle tendonitis can also lead to a long recovery especially if it’s not diagnosed and treated properly.
This will present as pain on the inside of your ankle near the bone.
Cause of Posterior Tibial Tendonitis
This is another ankle injury that is caused by increasing mileage or speed work too quickly.
Every step you take while running forces your posterior tibial tendon react to support the arch in your foot.
What’s more is that if you have low arches in your feet, flat feet, weak hips allow foot to fall inward or improper running form, it’s thought that you’re even more at risk for this. The result is inflammation posterior tibial tendon and a good deal of pain for you.
Solutions for Posterior Tibial Tendonitis
Most likely your posterior tibial tendon is injured, but not completely torn. But, you need to see a doctor to determine the extent of the damage. An orthopedist can assess your symptoms and examine your ankle for swelling and injury, and can use an x-ray or MRI to confirm the diagnosis.
👉Read more about the causes and a Posterior Tibial Tendonitis Recovery Plan >>
Since the reason for the tendonitis is overuse in the first place, you do need to dial back on your running. If you cool it a little, and it still hurts, or you’ve been diagnosed with posterior tibial tendonitis, you need to stop running before you cause permanent damage.
Stretching and strengthening the area around your ankle and up to your lower leg can help you start to heal. If it seems like you may be prone to this injury consider buying running shoes with additional arch support.
4. Peroneal Tendonitis
Runners are particularly at risk for peroneal tendonitis because of the repeated ankle movements.
The peroneal tendon connects the bone in your lower leg to that big knob of a bone on your ankle. You will feel pain and/or swelling on the outside of your ankle, and possibly up to your lower leg.
Cause of Peroneal Tendonitis
Peroneal tendonitis is another form of tendonitis that is also caused by the overuse of your ankle. The peroneal tendon connects the bone in your lower leg to that big knob of a bone on your ankle.
Increasing the labor of this tendon by doing too much too soon in terms of your running, can cause the peroneal tendon to become inflamed.
Additionally, if your feet roll outward when you run, you’re more likely to develop this injury.
Solutions for Peroneal Tendonitis
A physical therapist may be able to help you fix your peroneal tendonitis using physical therapy, or you will have to go to orthopedist to figure out a treatment plan. If they can’t feel the warmth or inflammation of a tendon, or get a confirmation on the diagnosis, they may use an x-ray or MRI to get a better look.
Either way you’ll have to back off on your running, and stop running altogether if the pain is sharp. To begin to alleviate your ankle pain, you can also change your running shoes or add insoles to give your arches more support.
👉Read more about Peroneal Tendonitis Treatment Plan >>
5. Ankle Arthritis
Ankle arthritis due to running can effect an athlete of any age. If you feel stiffness, loss of mobility, or an aching pain that increases with activity, it’s possibly being caused by either rheumatoid arthritis or osteoarthritis in your ankle.
Often this is the diagnosis once other issues have been ruled out and an X-ray has been done.
Many runners can run through ankle arthritis if it isn’t too severe, but no one wants to run in constant pain so we’ll look at some solutions.
Cause of Ankle Arthritis
The primary cause of arthritis is a degeneration of the cartilage.
This could occur from old injuries or could be the result of repeated poor running form. If you lean forward too much at the waist or hips, or pound too heavily with your feet, that could be negatively affecting your ankles. The ankle joint can become damaged or weak which results in the arthritis.
Solutions for Ankle Arthritis
- First, make sure you’re running with good form. Overstriding or feet rolling heavily inward or outward will strain the muscles, tendons and joints.
- Spend time on hip and glute strength to help provide stability to all your joints.
- Switch to a more stabile and cushioned shoe (I recommend Hokas) and avoid minimalist shoes. They need to be able to absorb some of the shock from the pounding so that your joints don’t have to.
- If possible, run on softer surfaces to help lessen the effect of the pounding.
- Finally, stretching, strengthening, and warming up your muscles can aid in keeping ankle arthritis at bay.
👉 Get some key tips for running with arthritis >>
6. Achilles Tendinitis
Achilles tendinitis occurs when the Achilles tendon, which acts as a connector between the calf muscles and the back of the heel bone (the calcaneus) becomes inflamed. It causes ankle pain and stiffness.
If you’re feeling burning or swelling on the back of your foot above the heel, it could mean your Achilles is inflamed.
Causes of Achilles Pain in Runners
The Achilles tendon is the largest tendon in our body and comprised of a thick band of tissue that connects the calf muscles to the heel bone. This tendon is responsible for every step we take, whether walking or running.
Which means once again when you increase intensity or volume too quickly, it can become inflamed.
Solutions for Achilles Pain
In the short term you need to stop running, stop doing anything barefoot and start focusing on a good treatment and prevention plan. An ice pack can help with immediately reducing pain, but you will likely find long term relief with some heat therapy.
Moving to a shoe with a higher heel drop and limiting treadmill use are two things that have helped many runners deal with this injury once they have moved through the pain and done some PT work.
👉Learn more about treating Achilles Pain While Running >>
7. Ankle Bursitis
The bursa is a fluid filled sack between your bone and ligament. You have them around all joints and never think about it until there’s an issue! Bursa are to cushion and reduce friction between ligaments, tendons, and bone.
This is yet another case of inflammation. You’ll notice pain, warmth and swelling.
Retrocalcaneal Bursitis is present at the back of the heel, almost along the same spot as your Achilles, which can make it easy to confuse the two.
Subcalcaneal Bursitis is present under the heel bone and can easily be mistaken for Plantar Fasciitis.
Causes of Ankle Bursitis
I bet you an guess some of them: overuse, tight fitting running shoes, lack of stretching, fat pad atrophy, and Achilles issues.
Treatment for Ankle Bursitis
As noted previously you’re going to need to stop running for a bit and start focusing on some key rehabilitation. Use NSAIDS to reduce inflammation and then put together a plan.
- Check your shoes, consider running insoles with more support
- Work on ankle flexibility
- Stretch the calves
Laser therapy has also proven useful for many runners.
8. Ankle Impingement
When overuse and stress of the ankle cause inflammation in the ankle joint ankle impingement occurs. Bone spurs can form on the front of the joint meaning you experience stiffness and pain in your ankle.
This is a less common issue, but a direct result of the ongoing lack of ankle mobility. Which means this is also preventable, by spending a little bit of time working on that!
Ankle Impingement or Athlete’s Ankle develops over a long period of time from chronic ankle instabilty. So it’s unlikely to be the issue of a newer runner.
9. Plantar Fasciitis
While this is a foot pain issue, it can also lead to ankle pain. First because the nerve is irritated and that runs up along the ankle creating the sensation of pain.
Second because we often alter our gait to reduce the discomfort coming from the pain in our heel.
If the majority of your pain is in the plantar fascia that runs under the heel of your foot and it’s worse in the morning, learn more about treating Plantar Fasciitis.
How to Prevent Ankle Pain from Running
As you can see, and may have even experienced, there are quite a few ways that ankle pain from running can occur. In each case, we’ve provided some initial ways to help prevent further issues.
But to recap, here are the keys to preventing your ankles from hurting while running:
- Ensure you aren’t running too much too soon leading to overuse
- Work on Ankle Mobility
- Spend time strengthening the ankle muscles
- Improve your running form to prevent overstriding
- Spend time foam rolling the calves and stretching the foot muscles
With a more serious ankle injury, or to ensure a minor injury doesn’t worsen, you need to involve a doctor.
See an orthopedist, preferably one who specializes in sports medicine to diagnose exactly what is wrong. From there you can get a course of action to put you fully on the road to recovery!
Whewwwww that was a ton of information. But if you’re still looking for more, some good resources:
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