Runner’s Ankle Pain: Causes and Treatments

Ankle Pain From Running: Causes and Treatments

Running is one of the most popular sports worldwide. In 2016, more than 64 million people went running or jogging in the U.S. alone and 24% of Americans stated that exercise was their primary reason to start running.

Are you a runner? Do you run to compete or do you run to keep fit? Have you ever experienced ankle pain while running? In this article, we will examine the different causes of runner’s ankle pain and the treatment that a physical therapist can provide to help you heal.

What is Runner’s Ankle Pain?

As the name implies, it is ankle pain that a person experiences during or after running.

Strong, healthy, functional knees, hips, and ankles are clearly important for running. However, the ankle is a common site of pain and injury related to running.  

What are the causes of Runner’s Ankle Pain and what treatments are available?

A study by a team from the University of Bern in Switzerland indicates that ankle injuries account for 28% of all running injuries. Here are the most common causes why you have ankle pain from running:

1. Ankle Tendonitis 

Causes and Treatment of tendonitis from running


Ankle tendonitis occurs when a tendon is inflamed. You develop ankle tendonitis from running because of the overuse of the tendon. It is often associated with excessive, repetitive movements.

Symptoms of tendonitis consist of pain, inflammation, and stiffness. With early diagnosis and proper treatment, a patient can recover from ankle tendonitis within two to three months.

What are the types of ankle tendonitis?

  • Achilles tendonitis

The patient feels heel and calf pain. Pain is felt when walking or running and can occur anywhere from the back of the heel up to the middle of the calf.

  • Posterior tibial tendonitis

The patient feels pain on the inner side of the ankle, usually when starting to push off through the foot.

  • Peroneal tendonitis

The patient feels pain on the back and outer side of the ankle when he/she stands or pushes off through the foot.

What is the treatment for ankle tendonitis?

  • Rest

Patients suffering from tendonitis are advised to refrain from activities that cause any pain or discomfort. If complete bed rest is not possible, they should at least reduce doing any activities as much as possible. Braces and splints can help reduce a patient’s movement.

  • Hot and cold compress

During the initial phase of healing (typically 48 to 72 hours following injury and involves pain and swelling), a wet ice pack should be applied. A wet ice pack can be placed directly on the skin for 15 to 20 minutes. If using a chemical ice pack, however, you need to use a barrier in between the skin and the ice pack (e.g. towel) to avoid chemical burn. When pain and swelling decrease, you can apply heat to draw blood to the muscle. This will help increase flexibility.

  • Physical therapy

Physical therapists can provide relief help accelerate the healing process through manipulating and massaging your ankle correctly. They can create an exercise plan that will strengthen your ankle.

2. Ankle impingement 

Ankle Impingement from running


Ankle impingement occurs when the soft tissues around the ankle are pinched or nipped. This happens when the ankle is fully bent up or down and this leads to front of ankle pain or pain in the back of the ankle. Impingement near the front of the ankle or anterior impingement is usually associated with past ankle sprains and impingement in the back occurs often with ballet dancers.

Symptoms of ankle impingement consist of decreased ankle mobility, feeling pinched in the front or back of the ankle, and inability to squat all the way down.

What is the treatment for ankle impingement?

  • Rest

You may be advised to rest the ankle for a short time to reduce the pain and swelling. A short-leg cast or special walking boot may be recommended to restrict ankle movement.

  • Mild pain medication such as Ibuprofen may be prescribed.


  • Cold compress

A wet ice pack placed on the affected area can alleviate swelling and can help regain normal ankle movement faster.

  • Steroid injection

Steroids are strong anti-inflammatory medications that can help relieve irritation and swelling in the soft tissues that are being pinched.

  • Physical therapy

Physical therapists can help patients regain the normal use of their ankles through an exercise program that includes stationary cycling, range of motion, and ankle strengthening.

3. Chronic Ankle Instability

Chronic ankle instability is a condition wherein the ankle “gives out” repeatedly while engaged in physical activities or when pressure is placed on the ankle. This condition affects the outside of the ankle, resulting in the inversion or turning in of the ankle.

Symptoms of chronic ankle instability consist of constant or recurring pain, swelling, tenderness and a feeling that the ankle may give out at any time.

Chronic ankle instability is usually the result of repeated ankle sprains that have not healed properly.

What is the treatment for Chronic Ankle Instability?

  1. Rest
  2. Cold compress to help alleviate swelling
  3. NSAIDs (Non-steroidal anti-inflammatory drugs) for pain relief and to reduce inflammation
  4. Wearing a brace or special boot or ankle support that will add stability to the ankle.
  5. Physical therapy to strengthen muscles in and around the ankle and to increase the patient’s flexibility, balance, and range of motion.

4. Tarsal Tunnel Syndrome

Tarsal tunnel syndrome is also known as the carpal tunnel syndrome of the ankle. Tarsal tunnel syndrome is a compression of the nerve (tibial nerve) that supplies the foot.

Symptoms of tarsal tunnel syndrome consist of numbness, tingling or a burning sensation similar to an electric shock, and sometimes shooting pain.

These symptoms are typically felt on the inside of the ankle and/or on the bottom of the foot. Sometimes symptoms appear suddenly.

The causes of the compression of the tarsal tunnel include arthritis, tendon swelling, and pronation of the foot.

What is the treatment for Tarsal Tunnel Syndrome?

  1. Rest the affected area to reduce pain and inflammation.
  2. Cold compress and elevation of the affected area.
  3. NSAIDs for pain relief and to help reduce inflammation.
  4. Steroid injections to help reduce swelling.
  5. Wearing of braces and splints to immobilize the foot in order to limit movement that could compress the nerve.
  6. Physical therapy exercises that can help reduce symptoms and accelerate healing.

Other Causes of Runner’s Ankle Pain:

  1. Wearing worn-out sneakers that do not have proper support for the feet
  2. Lack of structured motion in the feet.
  3. A past foot injury which you thought has healed completely (e.g. sprain).
  4. Excessive training without rest (e.g. long distance running).

If you still have discomfort in your ankle despite taking corrective measures such as purchasing new footwear with proper support, avoiding excessive training, stretching before exercise, etc., consult a health professional immediately.

If you are interested in physical therapy treatments for ankle pain, contact Vigor Physical Therapy & Rehabilitation today to schedule an appointment or ask us a question.