Running With Inside Ankle Pain
When I walk or run, I’m noticing an ache on the inside of my ankle.
Ouch! Yes, that does not sound like fun. Ankle pain is very limiting and it can be annoying if you’ve got a lot of things to do. Whether you’re trying to get things done around the house, or training for a half-marathon, it can put a wrench in your plans.
One of the reasons why I’m writing this blog is while training for my half marathon, I developed pain on the inside of my ankle and the arch of my foot. This was a frustrating situation because I had to continue training while trying figure out why my ankle was sore. This information isn’t just for runners though. I believe a lot of what I learned from my injury can be applied to people who experience ankle pain with their regular daily tasks.
I’ve written out what this may feel like to see if you’re suffering from the same injury as I was.
This diagram depicts some of the common tendons and structures of the ankle that may become irritated in an inner ankle injury.
What does it usually feel like?
It depends on how new or severe the injury is, or how recent. In most cases, it can be a constant pain if injured recently, which will eventually become more intermittent as time goes on. The pain is like an ache in the arch of your foot, or behind the bone known as your medial malleolus. You may notice it after activity when you are sitting and it may throb at rest.
What makes it worse?
Any weight bearing activities: walking, running, standing, squatting, lunging, or navigating stairs will make your ankle sore. Essentially, anything that requires putting weight through your feet. Pain will often increase when you are moving and worsen with more activity. Flatter shoes with less arch support or sandals will often worsen your symptoms.
What makes it better?
Rest and staying off your feet. Shoes that have more support around the arch. An ankle brace that supports the arch will be helpful. Certain taping techniques that support the arch of your foot will relieve the pain.
This sounds like me, what could it be?
There are a variety of options here anatomically:
The tendons:
Tibialis posterior tendon
Flexor digitorum longus tendon
Flexor hallucis longus tendon
Tendons are a muscle’s attachment point to the bone. When a muscle contracts or expands, the tendon is the bridge point which allows us to move our limbs. They act as levers to move your bones. Tendons are generally highly resistant but can easily be strained and inflamed if overloaded.
The ligaments:
Deltoid ligament
Spring ligament
Ligaments are like strong straps that hold two bones together. This provides strength to the joints of your body. If overstretched, ligaments can become sprained resulting in pain and instability.
Nerves:
Posterior tibial nerve
Medial plantar nerve
The nerves are the information highways that send electrical signals from your brain, through your spinal cord and into the limbs. They provide sensation to touch and signal muscles to contract and expand. If you have a pinched nerve, it can result in weakness of muscles, tingling and numbness. According to this study, 29.2% of ankle injuries can originate from the lower back.
The injury I had was tibialis posterior tendinitis. I’ll walk you through 4 different reasons why this can develop.
1. Sudden Increase of Distance
When I started training for my half marathon, there was a significant increase of distance and time running during the week. In my training regime, I decided to increase my long run distance from 10km to a 17km. I felt great afterwards, but my ankle hated me.
Whether it is running or walking, when you start a new activity, it’s important to increase distance slowly. To calculate this – add up the total amount of kilometers that you have run/walked in the week. A general rule is to only increase 10% each week if you decide to increase your distance. If you’re struggling to increase distance due to pain, you can try performing strengthening exercises to improve your endurance. Pain will sometimes surface if there is a muscular imbalance resulting in a compensatory pattern, or overuse of a specific muscle. Your physiotherapist can complete a comprehensive assessment to determine where the source of the problem is with a detailed history and completing special tests. With manual muscle testing, physiotherapists can determine the strength and endurance of a muscle to provide the exact exercise needed to strengthen your body. This will make increasing distance much easier versus pushing through pain and developing new injuries.
Another way to increase distance is to get comfortable with the current distance you are running for several weeks and then try go further. It could also be a matter of incorporating recovery runs and proper rest between each run. I found with my injury, if I ran consecutive days, my ankle did not have time to recover. I had to space out my runs every two to three days to allow my ankle to rest. On my off days, I would complete my exercises and ride the stationary bike instead of running. Riding the bike allowed me to get my fix for cardio that day, without compromising the healing of my ankle injury.
2. Awareness of your foot positioning
I was sore and frustrated with my ankle because I had just recovered from a long-standing back injury. I still wanted to run to maintain my progress for my half marathon without making my ankle worse, so I ended up taping the inside of my ankle to help increase comfort and decrease the perceived load placed on the irritated tendon. I used elastic therapeutic tape (also known as kinesiology tape or k-tape) which is a stretchy sport tape that provided some support in the inner part of the ankle.
Kinesiology tape on Corey’s foot and ankle providing increased proprioception.
I use the word “support” with caution with elastic therapeutic tape because of some of the discourse around why it helps with injuries. There is some debate as to whether tape can actually provide stability to certain parts of the body. If you are using a very rigid sport tape, I can see how tape would be able to provide extra support. But with kinesiology tape, it is believed to provide something known as proprioception. Proprioception is your body’s awareness of what that body part is doing in space. Tape around the ankle can remind you that you have an ankle injury, which will cue you to avoid specific movements that could aggravate it. Ankle taping may also give you feedback on how you are landing with your foot, leading to better running mechanics. Whether this allowed my muscles to fire a certain way, provided support, or increased proprioception – it worked! It allowed me to run with an injury without compromising my health.
Special tip from Corey: To those who feel they need more support, but only have kinesiology tape… Try adding two layers of tape to increase its rigidity.
3. Poor strength and control of the foot
When your ankle is weak in certain areas, it can cause compensatory patterns or overuse injuries. In my case, the inside of my ankle was weak resulting in an increased use of my tibialis posterior muscle, causing tendinitis. I ended up strengthening my foot by using isometrics, resistance band work, and eventually weight bearing exercises to strengthen this muscle. I also used this opportunity to strengthen other muscles around my ankle and foot to help the tibialis posterior. Who knew that toe strength was important for running mechanics! Your toes are actually extremely important as they determine what happens up the chain at your knee, hip and back. Click here if you’re interested in learning more.
4. Shoe wear
My increase in running distance during my training resulted in a worn-out shoe that had to be changed. I sheepishly admit that I continued to run in the same pair 100km past when they should have been retired.
Signs that my shoes needed a refresh:
I had to cinch up my shoelaces tighter to get better support through the upper fabric
The foam in the heel and midsole seemed to flatten out
Tread on the underside of the shoe had become shallower
My feet tended to ache more consistently after each run and worsen as I used the same shoe
The upper fabric was torn (might be the most obvious one!)
Shoes are an extension of your feet. If your shoe does not fit to your foot type (width or length), it can work against you and cause additional problems.
Proper shoe fit tips from Corey
Length of shoe
If you have a half to a full width of thumb space at the tip of the shoe, this can prevent black toes or cramping in the arch of your foot. If you have too much space, you will develop blisters from increased movement within the shoe itself. A sign that you have too much space in the shoe is when you have to lace up your shoes extremely tight to prevent your foot from sliding around.
Width of the shoe
You should be able to grasp some material on the upper fabric, but not enough to pinch and lift it off. Most running shoes do not stretch over time, so how they feel on your feet will be how they feel when you walk or run. Some people report a work in period for a shoe where it feels stiff for the first several kilometers, but this is different than an ill-fitting shoe with improper width. If your feet feel cramped or you develop pain in the arch or middle of your foot, the shoe may be too narrow. There are often shoe sizes that are labeled wider if you are flatter footed or have a very wide forefoot. Altra, Saucony, New Balance and Brooks have wide size options (although I wish the colourways were more exciting). For a narrow foot, most brands usually have sizes for people with normal to more narrow feet. I know this because I’ve not been able to fit into most brands and I’ve spent years finally realizing that there are only a select few companies that have a wide size fit. I’m sure someone with narrower feet might tell me otherwise, so feel free to email me if you have more information on this.
Stability and Cushion
Too much or too little cushion depending on the stability of your ankle can cause ankle injuries. Stability can be determined with an assessment of how stable you feel or look when you are standing on one foot. Generally, if you feel quite stable on one leg, a shoe with less arch support is sometimes more preferable. If you stand on one leg and notice that you knee buckles inwards, your arch flattens, and your opposite hip either hikes or drops, you may need a stability shoe. The only caveat to this is that you can strengthen imbalances of the ankle and hip to improve your single leg balance. To book an assessment to see which one you are, consult one of our movement specialists here.
Cushioning is based on personal preference at times. Those with less ankle stability or decreased proprioceptive awareness may prefer a stiffer sole whereas those with more stability and better proprioceptive awareness of the ankle enjoy ample cushion. Shin splints can often worsen with those who cannot tolerate a heavily cushioned shoe. Again, an assessment from a trained health professional, such as a pedorthist or physiotherapist, can help you choose.
Final thoughts
Ankles can be tricky! They hold the weight of your body and are essential for many daily tasks. Making sure that you are increasing distance slowly, building proprioception, improving strength in the ankle and wearing the right shoe can prevent inner side ankle pain. Having a clear understanding of factors that can cause your injury are important so you can get to the root of the problem.
If you are suffering from ankle pain, my recommendation is to come in for a comprehensive assessment in order to understand your pain and find the solution.
