Your ankles take a beating when you run, sometimes with up to 4 times your body weight on every step when running! So it’s quite likely that you’ll experience ankle pain from running at some point.
The good news is that you can build your ankles to be strong enough to minimize ankle pain. But if you experience aches in your ankles, there are also some great ways to treat it. The key, however, is to figure out what’s causing your ankle pain.
Do a bit of detective work and find out what’s behind it. This is the best way to treat it, recover properly, and move forward with stronger ankles!
How Common Is Ankle Pain in Runners?
Ankle sprains are the most common injury in all sports! And according to a recent study, the ankle is the most frequently injured joint in ultramarathoners, with around 34.5 percent of injuries affecting the ankle!
This includes Achilles tendonitis, tendinopathy, and ankle sprains as the two most common injuries. While this study was done with ultramarathoners, the data is similar for those running shorter distances.
The ankle plays a huge role in the running motion, so it takes a lot of strain when running. It’s also the point of stability on uneven ground, which means your ankle constantly stabilizes you when running. It undergoes a lot of stress during a run, so it’s particularly susceptible to injury.
Common Causes of Ankle Pain in Runners
The key to treating and preventing ankle pain in runners is to figure out what’s causing it. If you know the cause, you can treat it at its root rather than simply treating the pain itself. Ultimately, you can fix the problem if you know what’s causing it.
Some factors are more common than others in causing ankle pain. Before considering any other potential causes, make sure it’s not one of these things.
If you’ve never considered what kind of shoes work for your feet, this is the first thing you should consider.
There are four factors to look at when buying shoes:
- Fit: If shoes are too small, they can cause foot pain and chafing that alters your gait, placing strain on the ankle. They won’t offer the support you need if they’re too big. Ensure you get shoes that fit right—we recommend getting your feet properly measured.
- Pronation Type: Overpronators need a stability shoe, while neutral runners and supinators can get away with neutral shoes. If you aren’t sure which you are, check out this article for some easy ways to tell.
- Arch Height: High arches and low arches need different amounts of cushion underfoot to support the arch. Keep in mind that this is slightly different to your pronation—you can have high arches but not supinate, for example. Your shoes need to provide the right amount of arch support for your foot.
- Cushioning: There should also be enough cushioning under your feet to absorb shock and give you a comfortable run. Some people might be happy with minimalist shoes, but some runners might need more to protect their feet and ankle joints.
The Biomechanics of Your Feet
Your foot’s natural biomechanics can contribute to ankle pain if your feet aren’t properly supported.
For example, high arches are less good at absorbing shock, meaning the vibrations upon impact could affect your ankle more than people with regular arches.
On the other hand, low arches can force your foot to roll more than normal—overpronation—which places excessive pressure on your ankles as the foot moves out of its normal range of motion.
This plays into which shoes you should be wearing, so learning what kind of feet you have is essential to find the right shoes for your feet.
Poor Running Form
Even if your feet are well supported, and you’re wearing the right shoes for your biomechanics, poor running form can cause strain on the ankle.
On every step, your Achilles tendon and your calf muscle take on a lot of stress due to the vibration caused by the impact of your feet hitting the ground. Not only can this cause pain in both these areas, but it can also lead to pain in the ankle itself.
Overstriding is also a common form problem, and causes high impact and also forces your ankle to have to move through a greater range of motion in order to propel you forward.
Running on Uneven Surfaces
Running on perfectly even surfaces is not always possible, but running consistently on uneven surfaces means the landing force gets distributed unevenly across your feet.
One foot will take more of the impact than the other, and your form will most likely also be affected. This means that one side of your ankles gets a lot more strain than the other, which can cause pain.
Uneven roads or rough terrain can also cause strain on multiple different parts of the foot, including the joint, the ligaments, and the tendons. This could lead to a number of different injuries or conditions, all of which may lead to ankle pain.
When we say someone has weak ankles, most often we mean that the muscles, ligaments, and tendons around the ankles aren’t strong enough to support the joint adequately.
Without a strong support system, the ankle joint is more prone to moving out of alignment or becoming injured.
Weak, Tight, or Muscle Imbalances
Surprisingly, your ankles can become painful from weak, tight, or imbalanced calf muscles. When the calf is tight, it can pull on the heel bone and the plantar fascia, leading to different types of pain.
This can also make the ankle more prone to more serious injury, as your range of motion can be affected, leaving you much less flexibility.
Doing Too Much Too Quickly
Overdoing it can cause ankle pain. This happens most often when you go right into exercise without warming up properly. Cold muscles are more easily injured as it’s harder for them to move through their natural range of motion.
But it can also happen if you increase your distance, intensity, or frequency too quickly. This will lead to an overuse injury.
If you’ve had a previous ankle injury, you may be more susceptible to injuring it again. Take note of any weak points and support and strengthen your ankle before you run!
Overuse injuries are exceptionally common, especially among runners. Here are some overuse injuries that could be causing your ankle pain.
Tendonitis is very common. It’s when the tendons in the foot become inflamed and can cause pain, stiffness, and even swelling. There are many different tendons in the foot, so if you are suffering from tendonitis, it could be one of the following:
Tibialis Anterior Tendonitis
This occurs when the tendon that runs down the front of the lower leg becomes inflamed and painful. You’ll feel pain in the front of your ankle, and bending your foot upwards at the ankle joint may be difficult.
The Achilles connects the calf muscle to the heel bone, so when it becomes inflamed, you’ll feel pain in the back of the ankle along with possible swelling and stiffness.
This pain usually worsens with exercise. You may also experience heel pain or a “stretching” sensation under the arch.
Posterior Tibial Tendonitis
This type of tendonitis affects the tendon that runs down the inside of the ankle. You can expect to feel pain in that area, and you might be unable to rise up on your toes without pain. If this isn’t treated, it can lead to a collapsed arch on the affected foot.
Peroneal tendonitis affects the two tendons that run along the outside of your ankle. It can sometimes be mistaken for Achilles tendonitis, as you may feel pain up the back of your ankle but a little to the side of the Achilles.
This type of tendonitis can also present with pain on the outside of your foot just below your toes, as this where one of the tendons connects to the foot. It may also be mistaken for plantar fasciitis, as the other tendon connects under the arch and may cause pain there and higher up.
Stress fractures are the result of a lot of repetitive force on the same area of the foot. When the muscles become fatigued, they can no longer adequately absorb shock, which means the bone takes full force.
This is more common in runners with conditions like osteoarthritis, but it can happen to anyone, especially if you wear shoes without good cushioning. It’s less common in the ankle, but it does happen. Fractures in other places can also cause referred pain to the ankle.
You may be surprised to know that plantar fasciitis can cause ankle pain. Heel pain is the most common symptom, but when the nerves are aggravated, the pain can radiate to the ankles.
The pain may also cause you to alter the way you walk, which can place extra stress on the ankle joints and cause them to feel sore.
You’ll first notice a sharp, stabbing pain under the heel when you stand up after resting. You might also feel pain under the arch and a tightness in the strip of tissue under your foot.
In the areas where bones, tendons, and ligaments come together, you have small fluid-filled bubbles called bursae, which help to reduce friction. The main ones in the ankle are the Achilles bursa, retrocalcaneal bursa, and the bursa of the medial malleolus.
When these become inflamed, they can cause pain in the joint. You will experience symptoms in that area depending on which one you injure.
Pain and swelling in the area of the inflamed bursa. You’re likely to also experience a limited range of motion as the swollen bursa affects the movement of tendons, ligaments, and bones.
A sprain is an injury to the ligaments in the ankle. A strain is an injury to the muscles or tendons in the ankle. Both can cause pain, swelling, and a reduction in mobility.
The telltale sign of a sprained ankle is hearing a “pop” when you hurt it. You may also feel a “stretch” or “tear” in the affected area. Another sign that you have a sprain and not a strain is bruising which occurs anywhere from a few minutes to a few hours after the sprain.
You won’t experience a pop or bruising if you have a strain. You may also experience muscle cramps in the muscles surrounding the ankle.
Treatment Options for Ankle Pain
The RICE Method
The first thing to do is to Rest the ankle. Avoid putting weight on it and take a break from physical activity. Place some ice—covered in a cloth—on your ankle for 15 to 20 minutes. Give it a 15-minute break and repeat.
Once you’ve iced your ankle, wrap it in a bandage or use KT tape applied lightly to the ankle. You can also use compression socks to help stimulate circulation. Make sure it’s not too tight.
You should also try to elevate the foot above the heart while lying down. This will help drain any ankle fluid and prevent excess swelling.
Ankle Braces for Added Stability
An ankle brace can provide stability for unstable ankles, but we advise only wearing one if your ankle is actually unstable. If it can move through its natural range of motion without feeling like it’s going to give in, then we recommend taping instead.
Non-Steroidal Anti-Inflammatory Drugs
You can use NSAIDs to relieve the pain until your injury has healed. But keep in mind that you should only get back to running once your ankle is free from pain without the painkillers for at least three days.
It’s a great idea to do strengthening exercises for your ankles. You can include these in your warm-ups or just do them throughout the day, but they can help reduce your chance of injuring your ankle again.
Physical therapy can help to restore your full range of motion after an ankle injury. A physical therapist will also be able to give you exercises to regain strength in the ankle so you can get back to running.
Preventing Ankle Pain in Runners
Prevention is better than cure! Here’s how to set yourself up for the lowest chance of injuring your ankle or developing pain.
Warm-Up and Cool-Down Routine
Do a dynamic warm-up, including dynamic stretches and some running drills. You should focus specifically on your ankles, as they take on a lot of force, so you want them to be warm.
Doing some calf stretches is also worthwhile, as cold, tight calves can contribute to sore ankles.
Wear the Right Shoes
As we mentioned earlier, wear good running shoes that work best for you and your gait!
If you haven’t yet had your running shoes properly fitted and made sure they suit your pronation type, then this is essential. Make sure you’re using shoes with the right support, adequate cushioning, and enough of a lockdown on your feet.
Those wearing the right shoes should keep a close eye on them as they near the 300-mile mark. Pay attention to signs of wearing out, like flattened cushioning, holes, or smooth tread. Your shoes should be replaced every 300 to 600 miles.
Alternatively, try orthotics to provide more cushioning and support for your arches. This could be a good choice if you’re unable to get new shoes at the present moment.
Gradually Increase Your Mileage and Intensity
It’s tempting to push yourself hard to get ahead, but don’t! Slow and steady is the way to go, especially if you want to build a fitness base that’s sustainable and progressive.
You should increase by no more than 10 percent weekly. That goes for mileage, time, and intensity. This will give your body enough time to adjust to the new levels of exercise and prime your feet and ankles for it.
Improve Your Running Form
Get a coach if you can, as this is the best way to work consistently on your running form. If you can’t get a coach, we advise videoing yourself running on the road or on a treadmill and assessing your own form.
Foam Roll or Massage Tight Muscles
This is particularly helpful for tight calves that cause ankle pain. If you suffer from tight calves, get in the habit of foam rolling or massaging your calves at least 2 to 3 times a week. This will relieve pressure on the ankles and ease pain.
Cross-Train to Strengthen Supporting Muscles
Cross-training helps to give your regular running muscles a break and helps to strengthen supporting muscles that can help stabilize the ankle. Try easy activities on the ankles, like swimming, rowing, biking, or the elliptical.
Take Rest and Recovery Days
You should rest your ankles 2 to 3 times a week. That means one full rest day, on which you do no exercise at all, and at least 1 or 2 other “active rest days” from running, on which you cross-train.
Listen to Your Body
Don’t run through ankle pain. This can make the pain worse, and it can also turn a small niggle into a full-blown injury, which may have been able to heal if you stopped running.
Stop and take a break if you feel ankle pain during your run. If the pain persists when you start running again, stop your run completely, come home, and start treatment.
When Should You See a Doctor for Ankle Pain?
The good news is that most ankle pain from running can be treated at home, and you can take steps to prevent it. But how do you know when the injury needs medical attention?
Here are some signs that your ankle needs to be checked out by a doctor.
- The pain hasn’t subsided after a few days.
- You’re still unable to bear weight on the affected ankle after a few days.
- Prolonged swelling and redness in the area of the injury.
- Red streaks coming from the ankle.
- Reinjuring the ankle frequently.