The 6 Most Common Reasons for Ankle Pain while Running

This is my complete guide to ankle pain while running in 2021.

In this all-new article you’ll learn about the most common ankle pain diagnoses, as well as the most effective treatments (self-care included)!

ACHILLES TENDONITIS

ANTERIOR SHIN SPLINTS

ANKLE IMPINGEMENT

CHRONIC ANKLE INSTABILITY

TARSAL TUNNEL SYNDROME

PERONEAL TENDONITIS

ANKLE LIGAMENT SPRAIN

So if you want to get back to having zero ankle pain this year, you’ll love today’s article.

Note: read the disclaimer and always see a doctor first. If you need some help virtually (or in-person) the “Locally World Famous Chiropractors®” at Performance Place Sports Care are ready to work with you!

Let’s get started.

Ankle Pain When Running?

Ankle pain is a common complaint in the running world. Diagnosis range from Achilles tendonitis, peroneal tendonosis, and more. Common symptoms are a dull ache on the tendon, ankle pain when running, pain with walking, swollen tendon and tenderness. Causes include: excessive mileage, poor shoes, flat feet, low arches and poor gait.

Ankle Symptoms Check:

• Do you have a pinch inside your ankle?
• Does it feel like your tendon is swollen?
• Is it worse after you stop your run?

If so, you are not alone. These are symptoms of a possible “overuse” injuries of the ankle/ foot, which are often correctable through some of the methods I will go over in this article.

Hi, I’m Dr. Sebastian Gonzales. I own a rehab clinic in Huntington Beach, CA where we specialize in reduction of running injuries.

I’ve run many races from 5k’s to 1/2 Irons. I’ve experienced joint issues as a runner, just as you have, yet I’ve been fortunate to have a profession where I have an education to trouble-shoot “what works and what doesn’t work” to heal many conditions that cause ankle pain in runners.

I’m here to guide you through you’re search about recovering from ankle pain as a runner.

Believe me, this too will pass, just as it has with many other runners before you.

People recover from ankle pain everyday. All you need to do is duplicate what works.

This article will help explain the anatomy of the ankle, the features of ankle conditions that plague distance athletes and the treatments that can be used to correct it.

To accelerate your recovery, I’ve created a mini-guide I call “An Introduction Into The 9 Best Corrective Exercises For Ankle Issues.”

As we get into some of the treatments available for ankle issues, it’s always important to ask yourself WHY your ankle became irritated in the first place. Aside from direct trauma, most ankle issues are a painful, yet normal adaptation to load.

Pain is just an alarm.

Why is your irritated tendon being forced to become overused? Treatments that address pain, swelling, scar tissue and tenderness are used as simple ways to modify pain, similar to taking pain medication.

Pain modification is great, but only when coupled with recalibration of your body weight during gait.

Similar to like when your iPhone asks to be spun to recalibrate it’s GPS, most of the time ankle pain is the body asking to also redistribute load on the ankle when running… unless from trauma.

Recalibration is simple to do, yet most runners require a little guidance in finding their way… hence the reason I made the guide. It should be your starting point to recalibrating your ankle’s loading strategy.

The mini course is the most efficient way for me to guide you to the rehab exercise video’s you’re looking for (since ethical guidelines in the medical world restrict any doctor from recommending direct care without examination).

I included some videos of methods we use in clinic with high success in this article as a way of “unveiling the curtain.” I want you to see that recovery from an ankle issue is not magic and closer than you think.

The videos in this article are great and work sometimes but not all of the time. In my 10+ years of practice, I started to learn more effective corrective exercises to accelerate recovery for my clients. Many of the videos in this article will work BUT to be honest the newer stuff works FASTER. I started to compile video references in this PDF for my patients to use as “refreshers.” 

Ankle stretches, Active Release, manual treatments, rehab and avoidance of mileage are all ways we can decrease symptoms with ankle tendonitis, impingement and swelling… but let’s not overlook correcting the mechanism of injury (why it becomes “overused” in the first place).

I’ve divided sections of this massive article into the 6 most common ankle injuries you’ll experience a runner.

Within each section, you’ll find common signs, symptoms, causes, and some fundamental exercises that help many of the cases I see in my Huntington Beach clinic. For the more complex cases, I suggest you book a call with me, come in to see me in person or check out the book (when it comes live).

I believe most people can run again. I believe most most foot/ ankle issues runner’s experience is simply from improper loading… which can re resolved within a matter of weeks. Even in those situations where you’ve been told to “stay off” your ankle… most of the time these are still issues with load tolerance. When we “spread the load of running” to the intended structures of the body, magic happens!

25-50% improvement within a week and return to some form of running within the same week (in many cases)!

If you’re not able to get at least walking within a few weeks, then you better start trying something new (aside from fractures and post surgical cases). Just being honest because I care.

Dig through this article to learn more of the best free information about ankle pain recovery on the Internet. If you’re searching for effective suggestions on how to exercise/stretch the ankle, then you are definitely in the right place!

Disclaimer: This article is for educational purposes only and don’t be crazy. You still need a movement specialist or badass sports medicine rehab person to set you off on the right track. These are just things that work in my clinic.

I know when I had an ankle injury the pain with every step made me wonder if I would ever run again.

If you currently have an ankle injury from running you are not alone.

It sucks. Your friends are throwing down miles while you wait with the table reservation.

• Achilles Tendonitis
• Anterior Shin Splints
• Ankle Impingement
• Chronic Ankle Instability
• Tarsal Tunnel Syndrome
• Peroneal Tendonitis

ACHILLES TENDONITIS

Back Of Ankle Pain?

Achilles Tendonitis normally feels like a dull pain in the back of the ankle or back of the heel. Increases with walking stairs, stepping down curbs, running and jumping. Excessive swelling of the Achilles tendon is known as peritendinitis, as swelling if the synovial sheath that covers the Achilles tendon.

• Dull or sharp pain in the back of the ankle?
• Is it along that big tendon?
• Feels like there is a nodule there?
• Does it crack with walking?

Achilles Tendonitis is one of the top ankle injuries runners can get. Although it may only feel tight, dull and achy and gets better as you start to run, the scary part is this tendon can and does rupture.

That’s right. It detaches from the heel if the tendon is damaged and you don’t calm the irritation down.

Luckily, there has been extensive research on this condition.

You can prevent a rupture and better yet, be running again without a thought in the world about the injury that has plagued you for the past 3 months.

What is Achilles Tendonitis?

Achilles Tendonitis is an irritation to the large tendon in the back of the ankle. This tendon connects two muscles to the heel, the gastrocnemius and the soleus. The tendon allows the two muscles to point your toes toward the ground.

What causes Achilles Tendonitis?

When the Achilles tendon is under excessive load, either repetitively or all at once, it can become damaged. Tendons can fray, tear and detach. In the case of tendonitis, it is frayed, torn and swollen.

The nodules you feel are swelling within the tendon (true tendonitis) or around the tendon (peritendonitis).

What causes the tendon to become overloaded?

With running, we say it is from overuse, BUT we have to wonder why your right ankle hurts and your left doesn’t.

Didn’t you take equal steps on both feet?

This devil’s advocate says that there could be more going on than meets the eye. Yes, you took lots of steps, but often gait abnormalities, asymmetries, and muscular imbalances can force one Achilles tendon to do more work than the other.

So, shouldn’t we look at the other ankle? The other knee, thigh, hip and core?

Sure we can say it is from overuse, but that is only part of the story.

Achilles Tendonitis Rehab

If we look at it narrowly under the microscope, we would say we should only apply treatments and rehab exercises to the ankle.

But now that we have exposed there is more than meets the eye, we NEED to address the rest of the body too, or this will just come right back.

Rehab for an ankle allows us to take a look at strength, coordination, endurance and stabilization of the core, pelvis, hips, knees, ankles and feet on both sides.

But let’s not forget, we should do some work with the ankle locally too.

Eccentric calf raises have been a staple in the rehab of Achilles tendons for years. This is just one of the many corrective exercises you’ll need to address on-going Achilles issues. Here’s my guide to more that you’ll need.

Here is a video of how we perform it in the clinic.

Achilles Tendonitis Treatment Options

Here are some treatments that can greatly assist in decreasing pain and swelling with Achilles Tendonitis:

• Active Release Technique
• Deep tissue massage
• Anti-inflammatory injections
• Prolotherapy
• Chiropractic adjustments or mobilizations
• Strength training/rehab
• PRICE therapy
• Running gait training

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ANTERIOR SHIN SPLINTS

• Building miles and developed shin pain?
• Achy?
• Can you feel it when you lift your toes up?

Anterior Shin Splints often occur with newer runners, but can also afflict seasoned runners who are attempting to build more weekly volume.

It comes on fast and is very easy to forget about in your normal life. But man, when you start to run again, it comes back again as if it never left.

Let’s nip it in the bud right now.

You can run again without shin pain.

Read through my article. You’ll get information on what it is and how it is treated.

What is Anterior Shin Splints?

Anterior Shin Splints is by definition, pain in the front of the shin… not the side or the back.

The muscles of that region are the tibialis anterior, the extensor digitorum longus and the extensor hallicus longus. These muscles have very simple functions, so don’t let the names fool you.

They make it so you don’t trip on your toes when you run.

Irritation of this area leaves it feeling tight, tender and painful to run on.

What causes Anterior Shin Splints?

The cause of the pain of Shin Splints would be a debatable topic.

What could it be?

• Irritation to the muscles in the area?
• Irritation to the tendons in the area?
• Irritation to the bone interface (where the tendon attaches to the bone)?
• Breakdown of the bone from impact?

Normally, all of these are aspects of the injury and need to be addressed based upon how severe they are (i.e. if there is a stress reaction, you need more rest).

However, since all of these structures become injured at the same time, we can’t tell what is causing the pain.

Simply put, you didn’t plan your time well enough to slowly build your mileage. Because your shins weren’t ready for your fast and furious plan, you got Shin Splints.

Anterior Shin Splints Rehab

This is one of those rare conditions where rest is at the top of the list, especially if there is an injury of the shinbone.

Rehab can start during the down time though. Often, shin splints occur in people who have had ankle injuries in the past.

The past injury does not have to be a sprain. Simple tendon irritation in the past can set you up for a higher risk of shin splints.

Rehab would center around locally stabilizing the ankle through:

• Ankle Band exercise
• Short Arch exercise of the foot
• Proprioception and balance exercises

Here is an exercise series we use for the ankle band portion.

Global stabilization of the rest of the core and leg would be very productive during this time as well. You might as well since you won’t be running, right?

Here are some things we often recommend.

Anterior Shin Splints Treatment Options

Anterior Shin Splint pain can be decreased with the following treatments, but not as a substitution for down time.

These treatments can assist in your pain.

• Rest
• Active Release Technique
• Deep tissue massage
• Anti-inflammatory injections
• Prolotherapy
• Chiropractic adjustments or mobilizations
• Strength training/rehab (see video below)
• PRICE therapy
• Running gait training
• Dermal Traction 

ANKLE IMPINGEMENT

• Decreased ankle mobility?
• Can’t squat down the whole way?
• Pinch in the front of the ankle?

These are all signs of ankle impingement. Ankle impingement is not an extremely painful condition until it is…

I know it sounds dumb, but it’s true.

Most runners don’t care about their ankle mobility, but it is actually important for injury prevention.

Poor ankle mobility and function often leads to other ankle/foot injuries, and since you ended up on this page, I’m guessing you already have something already.

In this article, I will go into what ankle impingement is and how it can be rehabbed and treated.

What is Ankle Impingement?

Ankle Impingement is a pinch mechanism injury in the ankle.

What is being pinched?

It could be a few things.

• Bone formation that may normally not be there
• Fluid coming out of the ankle joint
• Cartilage growth

There are a few more possibilities, but regardless, this pinching effect creates further irritation and eventually, long term disability.

If you have read some of my other articles on injuries, you may have heard about “pinch versus stretch.”

What causes Ankle Impingement?

The “Pinch versus Stretch” concept is important with Ankle Impingement.

A structure is being caught in the front of the ankle when you move it. The structure can be composed of something hard, firm or soft.

A hard pinch point would be a bony block.

A firm pinch would be cartilage, tendon, ligament or muscle.

A soft pinch would be a fluid pocket.

It’s just like the reason why you wear green on St. Patrick’s Day… no one likes to be pinched.

How can you rehab Ankle Impingement?

Rehab for Ankle Impingement revolves around stabilization of the ankle and foot joints. There are more than 20 joints in the ankle and foot, so we have a lot of work to do.

It is very close to what we would do for other ankle injuries.

• Ankle band exercise
• Short arch exercise of the foot
• Proprioception and balance exercises

Here is the ankle band series we like to use.

The green band in the video is a moderate resistance and if it is too hard you can get red or yellow bands.

Ankle Impingement Treatment Options

Here are some techniques I recommend using for increasing mobility of the ankle. We have to free up the impingement, but it really depends on what is being pinched.

The type of impingement you have will dictate which of the following treatments can be more useful.

• Active Release Technique
• Deep tissue massage
• Band assisted ankle mobilization
• Anti-inflammatory injections
• Prolotherapy
• Chiropractic adjustments or mobilizations
• Strength training/rehab
• PRICE therapy
• Running gait training

CHRONIC ANKLE INSTABILITY

• Have weak ankles?
• Turned them more than twice over the years?
• Had more than five injuries to the ankle and foot over the years?

Chronic Ankle Instability is one of the “hidden” reasons behind many ankle and foot injuries that runners develop.

In baseball, we focus on shoulder health.

In running, we focus on ankle and foot health.

Having weak ankles creates a very high risk of future injuries in running.

This article will go more into what Chronic Ankle Instability is and how we rehab it in our office.

What is Chronic Ankle Instability?

Chronic Ankle Instability is a “weak ankle.”

It can be broken down into two types:

• Functional instability
• Mechanical instability

What causes Chronic Ankle Instability?

Mechanical Instability is present in the situation of a major tear of one or more of the ligaments stabilizing the ankle.

Functional Instability is a theory that has not had much research-based weight backing it, but it’s been found that mechanical instability alone can not be the only reason.

Think of ankle instability as a rickety old bicycle.

I can relate because my Walmart Huffy is just this way. Its bolts are loose, the rims are crocked and the seat spins around when I get on and off, but if I know I am careful, it can last a long time.

My last Walmart bike actually just died. RIP. I jumped on too rough one day and… it was a goner.

Unstable ankles are the same way.

Do you really want to have Walmart ankles?

Chronic Ankle Instability Rehab

You are in luck. We have a system for rehabbing weak ankles.

But the crummy part for you is that in the beginning, it does not include running or jumping. In fact, those two activities are the worst thing you can do on an unstable ankle.

If you haven’t figured it out by now, much of the rehab for ankle and foot injuries are similar.

This is why we started making online courses in the first place.

• Ankle band exercise
• Short arch exercise of the foot
• Proprioception and balance exercises

Here is the ankle band protocol we start almost all ankle injuries on.

Chronic Ankle Instability Treatment Options

Ankle Instability often occurs with tendonitis and muscle pain.

These treatments can greatly assist in improving pain levels.

• Active Release Technique
• Deep tissue massage
• Band assisted ankle mobilization 
• Anti-inflammatory injections
• Prolotherapy
• Chiropractic adjustments or mobilizations
• Stability work of the foot and hip (best option)

TARSAL TUNNEL SYNDROME

• Numbness in the foot?
• Feels like ants crawling on you?
• Worse with wearing tight shoes?

Tarsal tunnel is a nerve compression injury that often creates sensation changes more than pain. It can be painful in the later stages though.

Releasing the nerve, manually or surgically, can greatly assist.

What is Tarsal Tunnel Syndrome?

The tarsal tunnel is the carpal tunnel of the ankle. Just like carpal tunnel syndrome, tarsal tunnel syndrome is a compression of the nerve that supplies the foot.

The nerve is called the tibial nerve.

This nerve can become swollen if compressed.