Foot & Ankle Pain Running

Written By: Chloe Wilson BSc(Hons) Physiotherapy
Reviewed By: FPE Medical Review Board

So here we will look at the most common causes of ankle pain from running, how to tell them apart, how to treat them and also, how to prevent them.

Why Do We Get Ankle Pain Running?

Foot and ankle pain from running is usually caused by a combination of:

1. Muscle Imbalance

Weakness and/or tightness in the foot, ankle, calf, knee and hip muscles are a common cause of ankle pain running. Muscle imbalance can make subtle changes to the position of your foot when it hits the ground, which can place certain structures under more stress and lead to foot and ankle pain when running.

2. Overuse 

3. Previous Injuries

If you have had a previous foot or ankle injury, you are more likely to suffer from ankle pain running. How many people wait until they’ve fully recovered from an injury before returning to running? The temptation to get back out there is often just too great and people start training too much, too soon, and their body doesn’t have a chance to fully heal.

Maybe it’s just some mild discomfort, maybe the ankle feels a bit weak and wobbly. But they’re fed up of doing the exercises and rehab, and just want to get back running. The niggles continue and we ignore them until one day, it’s too much, we re-injure ourselves and the ankle pain running returns.

4. Bony Problems

A problem with the bone such as a break in one of the bones, stiffness or excessive bone growth in a certain area is another possible cause of ankle pain running. The foot needs to be flexible in order to move smoothly in the different phases of running, so anything that interferes with that can lead to pain.

5. Running Shoes

Wearing old or ill-fitting shoes is another common cause of foot and akle pain from running. Do you know how often you should change your running shoes? The advice on the block is approximately every 500 miles.

Factors such as running surface and body weight have an impact but on average that means if you run 5 miles a day, three times a week, you should be getting new shoes approximately every 7-8 months. Shoes lose their cushioning, their shock absorption and some of their shape, all of which places more strain on the ankle.

Causes Of Foot & Ankle Pain Running

There are a number of things that cause foot and ankle pain running and they can affect different parts of your foot.

1. Ankle Sprain

One of the most common causes of ankle pain running is a ligament sprain. There is a whole network of ligaments around the ankle joint that hold it together and keep it stable. Ligaments join bone to bone, and whilst they are very strong, they are not particularly flexible so get damaged if over-stretched.

Most runners will experience an ankle sprain at some point – their foot suddenly catches and twists (most commonly inwards) and they roll over on their ankle. If an ankle sprain is not fully rehabbed, it will most likely cause ongoing instability and foot and ankle pain running.

2. Peroneal Tendonitis

Another common cause of foot and ankle pain running is peroneal tendonitis. The two peroneal tendons are found on the outer side of the ankle and also help with ankle stability. They work hard during running during the push off phase (plantarflexion). Overuse leads to inflammation and small tears in the tendon resulting in ankle pain running

3. Posterior Tibial Tendonitis 

Inner foot and ankle pain running is often caused by posterior tibial tendonitis. The posterior tibial tendon is found on the inner side of the ankle, connecting the tibialis posterior muscle to the foot. Its main function is to stabilise the ankle joint – picture a suspension bridge, the posterior tibial tendon is the huge steel cable under tension to keep the whole bridge (i.e. foot) from collapsing. 

4. Tibialis Anterior Tendonitis

Another common cause of ankle pain running is tibialis anterior tendonitis. The tibialis anterior is found across the front of the ankle connecting the tibialis anterior muscle to the foot bones. It's main function is to dorsiflex the foot (pull it upwards), making it extremely important for foot clearance when walking, but it also helps to turn the foot inwards.

What Is It? Inflammation and degneration of the tibialis anterior tendon from overuse or repetitive activities e.g. kicking and jumping

Symptoms: Localised pain and tenderness across the front of the ankle, weakness and difficulty with dorsiflexion which can lead to people tripping as their foot doesn't clear the floor cleanly as they walk. Tibialis anterior tendonitis is a common cause of ankle pain running affecting around 10% of runners at some point.

You can find out all about the causes, symptoms, diagnosis and treatment options in the tibialis anterior tendonitis section.

4. Tarsal Tunnel Syndrome

One of the most common causes of foot and ankle pain running that gets misdiagnosed is tarsal tunnel syndrome. The posterior tibial nerve passes through a passage on the inner side of the ankle known as the tarsal tunnel. 

What Is It: Compression of the posterior tibial nerve as it passes through the tarsal tunnel, usually due to abnormal foot position (over-pronation) or following an injury.

Symptoms: Burning pain across the inner side of the ankle into the arch of the foot. There may also be pins and needles and/or numbness in the sole of the foot (which distinguishes it from plantar fasciitis). Increase in symptoms and ankle pain running or when standing for long periods

You can find out loads more about the common causes, diagnosis and treatment options in the Tarsal Tunnel Syndrome section.

5. Achilles Tendinopathy

Achilles tendonitis is the most common cause of posterior ankle pain running. The Achilles tendon is found on the back of the lower leg and connects the calf muscles to the heel. It is an extremely thick tendon and very strong – it can cope with forces up to twelve times body weight. But, it is not very flexible. 

6. Retrocalcaneal Bursitis

Another possible cause of posterior foot and ankle pain from running is retrocalcaneal bursitis. Bursa are small fluid filled sacs that sit between bone and muscles/tendons to provide cushioning and prevent friction. The retrocalcaneal bursa is found on the back of the heel between the heel bone (calcaneus) and the Achilles tendon.

7. Plantar Fasciitis

Plantar fasciitis is a common cause of foot pain in runners. The plantar fascia is a thick band that runs along the sole of your foot from the heel to the toes. It helps to support the foot arches and transmits forces through the foot when running and walking

8. Shin Splints

A common problem for runners, shin splints affect the lower leg down to the front of the ankle.

What Is It: A combination of inflammation and/or small tears in the muscles and/or bone on the front of the lower leg. It is usually caused by a combination of abnormal foot biomechanics, muscle tightness and weakness, overtraining and running on hard, sloped surfaces. Usually affects both legs but more prevalent in a runners dominant leg. AKA Medial tibial stress syndrome

Symptoms: Generalized dull, achy shin and ankle pain running – may become a sharp pain as it gets progressively worse. Worse with activity, better with rest. Simple test – resist the movement of dorsiflexion (lifting your toes up) – pain with this indicates shin splints

Find out more about the causes, symptoms, diagnosis and treatment options in the Shin Splints section.

9. Ankle Impingement

Ankle impingement is one of the less common causes of ankle and foot pain running. The ankle joint is made up of two bones, the tibia (shin bone) and talus (part of the foot) and is lined with thick layers of spongy cartilage which acts as a shock absorber. The bones glide and roll on each other as the ankle moves.

What is it: Repetitive force through the front of the ankle joint leads to inflammation and the formation of bone spurs at the front of the joint which leads to pain and stiffness in the ankle, particularly when dorsiflexing the foot. Usually develops due to muscles tightness, overtraining, poor balance, abnormal biomechanics, after ankle sprains or with repetitive activities involving end range dorsiflexion such as deep squats or landing jumps

Symptoms: Dull ache at the front of the ankle when resting, sharp anterior ankle pain running and walking (worse with increased activity), swelling, pain with deep squats, lunges or landing a jump

Treatment: RICE (rest, ice, compression and elevation), anti-inflammatories, physical therapy, balance exercises, and in persistent, severe cases surgery may be recommended.

10. Stress Fractures

Stress fractures can occur in any of the foot bones, but most commonly affect the metatarsals. 

Ankle Pain Running Summary

There are lots of possible causes of foot and ankle pain from running usually related to muscle imbalance, over-training, previous injuries, problems with foot biomechanics or simply from wearing the wrong shoes.

The location of foot and ankle pain running can help us to work out what is causing the problem:

Top of foot pain running is usually caused by extensor tendonitis, tight fitting footwear or a stress fracture

Side foot pain after running may be due to a ligament sprain, tendonitis or a stress fracture

Outside foot pain after running is usually due to peroneal tendonitis, cuboid syndrome or a ligament sprain

Medial foot pain from running may be caused by posterior tibial tendonitis, accessory navicular syndrome or tarsal tunnel syndrome

Shin pain from running is usually doe to shin splints

Heel pain after running is often due to achilles tendonitis, retrocalcaneal bursitis or a bone spur

Foot arch pain from running may be caused by plantar fasciitis, muscle cramps, plantar fibroma, accessory navicular syndrome or tendonitis

Ankle pain running is often caused by a ligament sprain, muscle imbalance or ankle impingement

Treatment for ankle and foot pain running will depend on the underlying cause of the pain and whether there is any instability or underlying damage.

Muscle imbalance is a common cause of foot and ankle pain running so strengthening and stretching exercises can make a big difference and are one of the best treatments for foot and ankle pain running.

You may also be interested in the following articles:

• Pain On Top Of Foot
• Foot Arch Pain
• Side Foot Pain
• Foot Lumps & Bumps
• Swollen Feet & Ankles
• Foot Numbness
• Foot Pain Diagnosis

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Page Last Updated: 11/12/23
Next Review Due: 11/12/25