Why Do My Ankles Hurt When I Run? 6 Possible Causes + Simple Fixes

Did you know that the average runner takes 1700 steps every mile? That’s a lot of repeated impact on the legs, so it’s no wonder a runner’s ankles might hurt, or even risk injury. Many of us have asked ourselves, why do my ankles hurt when I run?

Let’s help you answer that question today.

If your ankles hurt when running it’s important to identify the injury and ensure it’s treated correctly before continuing, as running on an injury is likely to make it worse over time and could damage your future ability to run.

However, running shouldn’t have to hurt. This article will break down 6 potential causes of why your ankles hurt when running as well as how to treat it, helping to get you pain-free and back in the game. We will discuss:

  • Ankle Sprains and Ankle Strains
  • Ankle Tendonitis
  • Ankle Stress Fracture
  • Ankle Bursitis
  • Sinus Tarsi Syndrome
  • Ankle Arthritis

We’ll also cover what to do to address each of these issues, when to seek further medical assistance, and key tips to prevent ankle injuries altogether.

Let’s jump into it!

Why Do My Ankles Hurt When I Run

6 Possible Causes to anwer: Why do my Ankles hurt When i run?

#1: Ankle Sprains and Strains

A sprain is the tearing or overstretching of a ligament (the tissue that connects bones to each other).

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.

Symptoms of a sprain:

  • Pain (especially when stretching the ankle)
  • Swelling
  • Bruising (localised to a particular area)
  • Inability to move the ankle

Symptoms of a strain:

  • Pain (localised to a particular muscle or tendon)
  • Swelling
  • Cramps
  • Muscle spasms
  • Difficulty moving the ankle

Causes:

Sprains and strains are usually caused by a single injury such as rolling the ankle, as opposed to most of the other injuries we will discuss in this article which are caused by overuse. This often makes them easy to identify.

Sprains and strains are often a result of not warming up properly, lack of conditioning, tiredness, and fatigue (meaning you’re less likely to carry your body properly).

Treatment:

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.

Why Do My Ankles Hurt When I Run

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 in order to reduce swelling and inflammation. Don’t apply ice directly to your skin. You can repeat this for the first couple days after the injury occurs.
  • 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 micro-tears can continue over time, making the problem more severe.

After a couple of days, gentle exercise and movement can help with the healing process by improving blood flow. Additionally, exercises that strengthen the calf and ankle muscles can reduce the risk of re-injury by improving balance and stability.

Most importantly though – listen to your body. If an exercise aggravates the symptoms then stop doing it.

If the strain or sprain is causing you pain, anti-inflammatory nonsteroidal drugs (NSAIDs) such as ibuprofen may help to reduce pain and inflammation.

A mild or moderate strain or sprain will likely heal within a week, a more severe injury (e.g. the complete tearing of a ligament – known as a Grade III sprain) will take a lot more time and potentially physiotherapy and/or surgery in order to heal.

Why Do My Ankles Hurt When I Run

#2: Ankle Stress Fracture

Stress fractures are tiny cracks in the bone.

Common Symptoms:

  • Pain that improves during rest, but worsens if running is continued. Pain is often localised in a particular area where the fracture is located. Pain may be sharp.
  • Minor swelling
  • Bruising
  • Tenderness

Causes:

Stress fractures are commonly caused by overuse by increasing mileage and/or intensity too quickly, poor running posture and imbalance, changing running surfaces, lack of cross-training, and sometimes improper nutrition (lack of vitamin D and calcium).

Treatment

It is very important to rest if you have a suspected ankle stress fracture. If an ankle stress fracture continues to be strained through running and left untreated, the cracking will worsen and you can end up with your ankle in a cast. 

Once again, the RICE method is recommended here.

It will generally take 1 to 3 months for a stress fracture to heal, after which running can be continued.

If you want to keep fit whilst your ankle injury heals, try swimming or cycling, as neither activity places the same strain on your ankles and will allow them to repair!

Why Do My Ankles Hurt When I Run

#3: Ankle Tendonitis

Tendonitis refers to the inflammation of a tendon. There are a number of tendons in the ankle that can become inflamed from running: 

  • 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).

Common Symptoms:

  • Localised pain in the region of particular tendon which is often described as a dull ache when the ankle is moved. It is likely to be bad in the morning yet get worse with activity. 
  • Swelling, tenderness and stiffness localized around a particular tendon.

Causes:

If caused by running, ankle tendonitis is usually a result of overuse, running too far or often, wearing the wrong shoes, or poor running form. Tendonitis can also be caused by having flat feet, low arches, or weak calf muscles.

It is worth noting that tibialis anterior tendonitis (located on the top of the foot) can also be caused by rubbing due to laces being too tight.

Whilst the symptoms are very similar to that of a strain or sprain, the key difference is that tendonitis is generally caused by repeated movement, as opposed to a single traumatic injury.

Treatment:

As with all of these injuries, make sure to take a break from running until it’s healed. 

Once again, the RICE method is recommended to reduce pain and swelling and speed up healing.

Try some gentle stretching of the calf muscles to help to regain strength and reduce stiffness.

Non-steroidal anti-inflammatory drugs (NSAIDs) can be used to reduce pain and inflammation. However, some research suggests it may be best to allow it to heal naturally if possible, as NSAIDs may interfere with the healing process. 

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. 

Why Do My Ankles Hurt When I Run

#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. retrocalcaneal bursitis is often mistaken for Achilles tendonitis.

Symptoms:

  • Pain, redness, warmth, and/or swelling localized at the back of the heel near the achillies tendon

Causes:

Overuse and/or overtraining, badly fitted or overtight running shoes, muscular imbalance, and/or poor running form. It may also develop if a case of Achilles tendonitis is left untreated.

Treatment:

Once again, it’s the classic routine of the RICE method as well as NSAIDs to treat the pain and inflammation if needed. 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. 

Why Do My Ankles Hurt When I Run

Symptoms:

  • Pain just in front of the lateral malleolus (aka the big bobble of bone on the outside of your ankle)
  • Swelling
  • Tenderness
  • Difficulty walking (particularly on uneven surfaces)
  • Bruising

Causes:

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. Poor running form, foot posture, and muscle weakness also increase the likelihood of development.

Treatment:

Wear supportive shoes whenever out and about, and work on strengthening the hip and leg muscles, as well as the foot arch.

#6: Ankle Arthritis

Osteoarthritis (a.k.a wear and tear arthritis) is when the cartilage around a joint degenerates, meaning the joint cannot absorb shock or glide smoothly as it should.

Symptoms:

  • Dull aching pain
  • Stiffness
  • Lack of mobility

Causes:

Whilst there is no evidence that the action of running itself causes arthritis, running combined with improper biomechanics can (i.e. muscular weaknesses and imbalances).

Treatment:

It’s recommended that you run on soft surfaces. You should also keep the ankle joint mobile, which keeps it lubricated but avoid sudden strenuous movements.

Again, NSAIDs are recommended if you experience significant pain.

Through strength training, you can work to improve the imbalances of the muscles around the ankle, helping to reduce pain and minimize degradation of the joint.

Why Do My Ankles Hurt When I Run

When should you see a doctor about your ankle pain?

If you have to ask yourself, why do my ankles hurt when I run?, according to Healthline, you should see a doctor if:

  • You experience significant pain for more than three days
  • You still can’t run after a week
  • You can’t walk or struggle walking
  • You keep experiencing the same injury
  • Your ankle feels numb or unstable
Why Do My Ankles Hurt When I Run

Key tips for Ankle injury prevention

Most of the aforementioned injuries are generally caused by your body not being properly prepared or conditioned when you run, or by imbalances and biological instabilities. Overpronation (where the foot rolls too far inwards as it hits the ground) is a very common cause of ankle injury from running but can be prevented.

Now that we’ve answered the question of ‘why do my ankles hurt when I run?’, here are some general tips to help minimize your risk:

  • Don’t push yourself and increase distance and/or intensity too quickly. Let your body rest
  • Strengthen leg and foot muscles, as well as the glutes and hips. If you’re sitting down at a desk all day you’re likely to have poor posture and muscular weaknesses due to inactivity, which can negatively influence the alignment of your ankle.
  • Let your injuries heal. If you’ve injured yourself once, you’re much more likely to injure yourself again, however, letting your injuries heal properly will minimise this risk.

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.

Why Do My Ankles Hurt When I Run
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Hailing from Brighton, UK, Felix is a lover of running, cycling, and all things active. When he's not exploring a remote corner of the globe on a bike-packing trip, Felix enjoys meditating, making music, and running as far as his legs will let him!

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