3 common causes of inner ankle pain while running

We asked our Physiotherapy team about the most common causes of inner ankle pain while running. This was their three most common causes and, more importantly, their most effective treatment for inner ankle pain.

Inner ankle pain while running is typically due to some form of overload. That may be muscles being overloaded beyond their capacity or it might be joints that are sustaining higher loads due to a lack of muscle bracing.

Once the overload begins, it generally causes the area to become sensitive which makes further episodes of inner ankle pain more likely.

What are the most common causes of inner ankle pain? And what are the best fixes for each injury?

Cause 1: Tibialis Posterior Tendinopathy

The Tibialis Posterior muscle, also known as Posterior Tibialis, is a muscle that runs down the inside edge of the shin, around the inside of the ankle and connects on to the arch of the foot.

As you can imagine, its main job is to control the position of the arch as you run. As you impact the ground during foot strike, the Tibialis Posterior must slowly lower the arch and control the rate of pronation.

If the muscle isn’t performing its task, either due to weakness or another deficit, it will rapidly stretch the tendon which wraps around the inside of the ankle.

This leads to an injury called Tibialis Posterior Tendinopathy, which causes inner ankle pain and some swelling around the inside ankle bone (medial malleolus) with a rope-like appearance.

Best treatment for Tibialis Posterior Tendinopathy

For a Tibialis Posterior Tendinopathy, the best treatment is to reduce the loading on the muscle while increasing its capacity.

You can reduce the loading on the muscle by using orthotics, supportive shoes or foot taping called Low Dye taping.

In order to increase the capacity of the muscle and tendon, you can perform eccentric (slow lowering) exercises.

The simplest example of this type of exercise is leaning against a wall on the same side as the leg (this puts the leg on an angle) and then raise and lower the arch.

Cause 2: ankle joint synovitis

Another common cause of inner ankle pain is due to overstretch of the joint capsule around the inside of the ankle.

This joint capsule has a very sensitive lining, known as synovium, which is prone to inflammatory reactions if it is overstretched or compressed.

The most common mechanism behind ankle joint synovitis for inner ankle pain is an overstretch mechanism. Essentially the inner part of the ankle stretches on impact due to poor muscular or physical stability at the ankle.

This diagnosis can be associated with some ankle swelling, although it tends to be localised around the ankle joint in a donut-looking pattern.

Best treatment for ankle joint synovitis

The best treatment for ankle joint synovitis is to attack it in three ways simultaneously.

Anti-inflammatory options, including anti-inflammatory medication and ice packs, can reduce the inflammatory response after each run.

Increased physical stability around the ankle, using orthotics, supportive shoes or even just new shoes, reduces pressure on the synovium.

Then you can add stability exercises to improve the ankle’s ability to brace itself on impact. These exercises should focus on bracing the ankle on solid ground while the body is pulled away from the centre of mass using a resistance band or a one sided weight.

Exercises using a Bosu ball or similarly unstable surface are almost useless as they train the ankle to continually follow an unstable surface rather than bracing on solid ground as we do in running.

Cause 3: subtalar joint pain

The last of our top 3 causes of inner ankle pain is due to subtalar joint overload.

This is an overload injury but that isn’t to say that you’re putting too much force through the foot.

It’s just that the subtalar joint, which is responsible for tilting the foot, is not able to move through the range of motion required of it when you’re running.

With each foot strike, the subtalar joint is forced beyond its tolerable range of motion due to a lack of stability or a lack of range or both.

As the subtalar joint becomes more painful, it becomes harder to stabilize the ankle in light of the inner ankle pain.

Best treatment for subtalar joint pain

The best treatment approach for subtalar joint pain is twofold.

You can improve the range of motion by doing lateral movement exercises or by receiving hands-on joint mobilization from a therapist.

The other treatment is to improve your ability to stabilise the ankle, which can be done through drills such as plyometric lunges, walking lunges or small hops (if they are pain free).

Other causes of inner ankle pain

Plantarfasciitis

Calcaneal bone stress

Tibial bone stress

Talar Dome lesion

Peripheral nerve irritation