Did you know that the average runner takes 1700 steps every mile? Multiply that by however many miles you’re running, and it’s easy to appreciate the hard work our ankles do for us.
According to a 2015 meta-review, the incidence of ankle-related running injuries varies between 3.9% – 16.6%.
Many of us have asked ourselves, why do my ankles hurt when I run? Let’s help you answer that question today.
In this article, we will look to provide the most common potential causes of ankle pain. We’ll also offer information on how to treat it, helping to get you pain-free and back in the game.
Our articles are not designed to replace medical advice. If you have an injury we recommend seeing a qualified health professional.
We will discuss:
- Why Do My Ankles Hurt When I Run?
- 5 Common Ankle Injuries
- How To Effectively Treat Ankle Pain
Let’s jump into it!
Why do my ankles hurt when I run?
If your ankles hurt when running it’s important to identify the root cause to ensure it’s treated correctly before continuing. Running on an injury is likely to exacerbate symptoms, and over time you could end up being unable to run for long periods.
Running can and should be pain-free.
There are many reasons why your ankles may be hurting when you run. However, there is one outlier that trumps the rest; overuse.In fact, overuse accounts for a staggering 80% of running injuries. Overuse is relative to the individual and results from a mismatch between the resilience of the connective tissue and the physical demands caused by running.
The good news is that injuries relating to overuse are completely preventable.
So why do the vast majority of us succumb to them?
Far too many of us run too hard, too often. It is extremely tempting to lace up your shoes and shoot out the door. You get a rush of endorphins and an impressive run to upload to Strava but at the cost of a slight niggle in the ankle.
As runners, we are often guilty of over-emphasizing the importance of time and distance rather than enjoyment.
One of the first questions you’ll get asked if you finish a race is… what time did you do it in? This question is pretty arbitrary, as we all live completely different lives. It is fun to run fast, and it can be interesting to get a gauge of your performance relative to others, but don’t let it dictate your training.
Having a structured training plan is an effective way to avoid overtraining. The plan should include a progressive increase in volume and intensity alongside adequate rest and recovery.
To further understand how you can prevent ankle pain when running, check out our in-depth guide on injury prevention, as well as how you can best support your ankles when running.
Now that we’ve discussed the general mechanism by which ankle injuries occur, let’s take a look at some specific injuries and their causes.
5 Common ankle injuries
#1: Ankle Sprain / Strain
A sprain is the tearing or overstretching of a ligament (the tissue that connects bone to bone).
A strain, also sometimes called a pulled muscle, is the tearing or overstretching of a muscle or tendon (the tissue that connects muscle to bone).
Both are often common causes as to why your ankles hurt after running.
Sprains and strains are usually caused by a single movement, such as rolling the ankle. This often makes them easy to identify.
Sprains and strains are one of those injuries that can just happen. A loose rock coupled with a beautiful sunset is all we need.
We can be more at risk of rolling the ankle if we do not warm up properly, run when tired, or push beyond the body’s limit (the muscles are less likely to react in time.)
Common Symptoms of a sprain:
- Pain (especially when stretching the ankle)
- Bruising (localized to a particular area)
- Inability to move the ankle
Common Symptoms of a strain:
- Pain (localized to a particular muscle or tendon)
- Muscle spasms
- Difficulty moving the ankle
Luckily, sprains and strains are very treatable. Experts generally recommend the RICE method (Rest, Ice, Compression, Elevation) to reduce pain and swelling and speed up healing.
Breakdown of the RICE method:
- Rest: Avoid using the joint and avoid putting weight on it.
- Ice: Wrap a towel or piece of clothing around a bag of ice and leave it on the injured area for 20 minutes, then take it off for 20 minutes. Repeat this process to reduce swelling and inflammation. Ice is most effective during the first few days after injury.
- Compression: Wrap the joint in a bandage or trainers tape to reduce swelling, but not too tightly.
- Elevation: Attempt to keep the injured joint above the level of your heart to reduce swelling and prevent fluid build-up.
It’s important that you don’t continue to run on a sprain or strain, as the body needs time to repair the tears.
Depending on the severity of the injury, gentle exercise and movement can help with the healing process by improving blood flow. Most importantly – listen to your body. If an exercise aggravates the symptoms then stop doing it.
Additionally, exercises that strengthen the calf muscles can reduce the risk of re-injury by increasing the resilience of the muscles and tendons surrounding the ankle.
If the strain or sprain is causing you pain, non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may help to reduce pain and inflammation. Do not use NSAIDs as a vessel to prematurely get back out on the trails.
With rest and gentle movement, a mild or moderate strain or sprain will likely heal within two to three weeks.
A more severe injury (e.g., the complete tearing of a ligament – known as a Grade III sprain) will likely take 3 months or more to heal. If this is the situation you find yourself in, seek out a physiotherapist to help you in the recovery process.
#2: Ankle Stress Fracture
Stress fractures are tiny cracks in the bone.
Stress fractures are commonly caused by overuse. Stress will accumulate over time if there is a mismatch between our body’s ability to manage load and the volume/intensity of the load it experiences during running.
Sometimes improper nutrition (lack of vitamin D and calcium) can also contribute.
Overuse injuries sneak up on us, and we often don’t know until it is too late.
- Pain that improves during rest but worsens when running. Pain is often localized in a particular area where the fracture is located. Pain may be sharp.
- Minor swelling
It is important to rest if you have a suspected ankle stress fracture. If you continue to apply force on the affected area the fracturing will progressively worsen, and you can end up with your ankle in a cast.
Most stress fractures will heal with noninvasive treatment. Depending on the severity of the fracture it will generally take 1 to 3 months for a stress fracture to heal.
Progressively loading the ankle, relative to the stage of recovery, is a crucial component of returning to fitness. This should be done with the help of a healthcare professional via a strength and conditioning program.
#3: Ankle Tendinopathy
Tendonitis refers to the inflammation of a tendon. However, inflammation is usually only present during the first stage of tendonitis; past that point, it is more accurately described as tendinopathy.
- Achilles tendon (connects the back of your heel to your lower calf)
- Tibialis anterior tendon (runs from the front of your shin down to your foot on the side of your big toe)
- Posterior tibial tendon (runs along the inner ankle)
- Peroneal tendon (runs along the outer ankle).
Tendinopathy is often caused by repetitive stress resulting in micro-trauma to the tendon. Usually, this is due to a sudden increase in loading activities, such as a long run or high-volume training period.
Whilst the symptoms are very similar to that of a strain or sprain, the key difference is that tendinopathy is generally caused by repeated movement, as opposed to a single traumatic injury.
- A localized pain in the region of the tendon is often experienced, described as a dull ache when the ankle is moved. It is likely to be bad in the morning yet worsen with activity.
- Swelling, tenderness, and stiffness localized around a particular tendon.
As with all of these injuries, it is recommended to rest in the short term.
A growing body of evidence suggests that incorporating a stretching program focussing on the calf complex can help recovery.
Additionally, high-load strength training may aid in a quicker reduction in pain and improve function.
Whilst the above three injuries are the most common causes of ankle pain from running, the following are a few less common potential reasons why your ankles hurt when running.
#4: Ankle Bursitis (Retrocalcaneal Bursitis)
Bursitis is the inflammation of the bursa, a fluid-containing sack in between the bone and ligament. The retrocalcaneal bursa is located in-between the Achilles tendon and ankle bone.
A mixture of overuse and overtraining, alongside badly fitted or excessively tight running shoes, may be to blame.
- Pain, redness, and warmth at the back of the heel near the Achilles tendon.
- Localized swelling at the back of the heel
Once again, utilize the RICE method as well as NSAIDs to treat the pain and inflammation if needed. There is some evidence to show that stretching the calf muscle may also help.
#5: Sinus Tarsi Syndrome
Sinus tarsi syndrome is a long-term inflammation in the soft lining of the ankle joint.
Sinus tarsi syndrome often develops after an ankle sprain or repeated ankle sprains.
If pain continues for more than 12 weeks after the initial sprain, it may be Sinus tarsi syndrome.
It is worth consulting a medical professional to get an accurate diagnosis.
- Pain just in front of the lateral malleolus (aka the big bobble of bone on the outside of your ankle)
- Difficulty walking (particularly on uneven surfaces)
Rest, active recovery, NSAIDs, and a progressive re-loading program.
How to effectively treat ankle Pain
Most of the aforementioned injuries are generally caused by the physical demands placed upon your body exceeding the physical capabilities it possesses.
Here are 5 key considerations to incorporate to prevent future injuries:
- Strength and conditioning work at a gym or at home really makes the difference. You can safely provide stimulus to muscles used in running without running. This will prompt an adaptive process to occur, increasing your body’s capabilities and thus reducing the risk of injury.
- Don’t increase distance and/or intensity too quickly. Your body can do amazing things, but it needs time to adapt. The 10% rule is can be a good starting point. Try to shift the focus from performance to enjoyment. Chances are you’ll get faster anyway!
- Give your body adequate time to rest. Rest can be active; a gentle walk or a slow cycle can do wonders. But sometimes we need to fully switch off, eat a big meal and get 8 hours of sleep.
- Warm up before running. Proprioceptively, a warm-up can work wonders, having all your muscles firing makes it less likely that you’ll roll an ankle.
- Don’t train through an injury. The road to recovery is not straightforward, there are blueprints to follow, but it will always vary between individuals. One thing is for sure, if you continue putting excessive stress on an injured muscle or tendon, it will get worse.