Ankle pain after running: causes and what to do
Ankle pain after running is common, particularly after increasing distance, adding trails or hills, or returning after an old sprain. Where it hurts is the best guide to what's going on.
What are the most common running injuries around the ankle?
A systematic review of running injuries found Achilles tendinopathy was among the most common, with an incidence of about 9% to 11% in runners, alongside shin splints and plantar fasciitis (Lopes et al., Sports Medicine, 2012).
Pain at the back of the ankle
Pain and stiffness in the Achilles tendon, worse in the morning and when starting a run, is typical of Achilles tendinopathy. Pain right where the tendon meets the heel is insertional tendinopathy, which needs a slightly different approach.
See our posts on Achilles tendinopathy and pain at the back of the heel.
Pain on the inside of the ankle
Pain behind and below the bony bump on the inside of the ankle, sometimes with the arch flattening, often comes from the tibialis posterior tendon. It's more common in runners with flatter feet and in women over 40.
See our post on inner ankle pain.
Pain on the outside of the ankle
Pain behind and below the bony bump on the outside of the ankle, worse on cambered roads and trails, usually comes from the peroneal tendons. Pain in front of that bump, especially after old sprains, can be ongoing ligament or joint irritation.
See our post on peroneal tendon pain.
Pain at the front of the ankle
A pinching pain at the front of the ankle, worse on uphills and in deep lunges, may be anterior ankle impingement, common after repeated sprains. Pain on the tendons across the front of the ankle can come from shoelaces tied too tightly.
Ankle pain after an old sprain
Many runners have one ankle that never quite recovered from a sprain. Ongoing pain, swelling after runs, and a feeling of the ankle giving way on uneven ground point to weakness and reduced balance that respond well to rehab.
See our post on ankle sprains and instability.
Could it be a stress fracture?
Pain on one spot of bone around the ankle or foot that's getting worse with each run, hurts with hopping, or aches at night may be a bone stress injury. Stop running and get assessed.
See our post on stress fractures and other shin pain.
What causes ankle pain in runners?
Usually a change: more distance, more hills or trails, faster sessions, new shoes, or a return after a break. A systematic review of running injury risk factors found the main one was a previous injury in the last 12 months (Saragiotto et al., Sports Medicine, 2014), which is why rehabbing old sprains properly matters.
What should I change in my training?
Reduce weekly distance for a couple of weeks, choose flatter and more even routes, drop speed work and hills, and keep pain during and after runs mild. Build back gradually.
What exercises help?
Calf raises (progressing to single-leg and slow), balance work on one leg, hopping drills once pain allows, and hip strengthening. Resistance band exercises for the ankle in all directions help tendon problems on the inside and outside.
See our post on strength training for runners.
Do shoes or braces help?
Comfortable shoes and a gradual approach to any change matter more than a specific model. A brace or taping can help an unstable ankle on trails while you rebuild strength and balance.
When should I get it checked?
Book in if ankle pain isn't improving within a couple of weeks of reduced running. See a doctor promptly for inability to bear weight, significant swelling or bruising after a roll, focal bone pain, or a hot, red, swollen ankle.
Is it normal for my ankle to be stiff after a run?
Mild stiffness that eases within a day is normal, especially after longer or harder runs. Stiffness that's worse the next morning, takes longer to loosen, or builds week to week suggests a tendon is overloaded.
Should I run through ankle pain?
Mild tendon pain that stays low during a run and settles within 24 hours is generally acceptable. Pain that makes you change how you run, limp, or is sharper each time means stop and reduce.
Does running surface matter?
Trails and cambered roads load the tendons on the inside and outside of the ankle more than flat, even surfaces. If those areas are sore, use flat routes for a few weeks, then reintroduce trails gradually as strength and balance improve.
How can an osteopath help?
We pinpoint the structure involved, assess the foot, ankle, knee and hip, refer for imaging when needed, and guide strength work and a graded return to running.
See our knee and ankle pain guide and our training hub. Book an assessment at our Berwick clinic. A 60-minute initial consultation is $149, with no referral needed and HICAPS on-site.
Sources
Book an initial consultation at RISE Sports & Spinal in Berwick. Clear diagnosis, hands-on treatment, and a plan that actually gets you better.
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