Running is an excellent workout but it puts a lot of stress on various lower leg joints and bones, such as your heel, toes, and knees.
But perhaps the most popular part that a lot of runners suffer from while running long distances is the ankles, which leads a lot of us to wonder “why do my ankles hurt when I run?”
To help you find an answer to this popular question, we’ve put together a complete guide with everything you need to keep in mind regarding this problem, including symptoms, causes, possible treatments, and tips to prevent ankle injuries in the future. Let’s dive in!
Understanding Your Ankle
To have a better understanding of all the possible symptoms, conditions, and causes of ankle pain, you need to know how the ankle works.
The ankle is essentially an area that contains two joints, each one of them is responsible for a specific type of movement, including being able to go up and down as well as from side to side.
The ankle joint is also responsible for connecting the heel bone, which is called “talus”, with your shin bone, which is scientifically known as the “tibia”.
The fibula is another bone that is adjacent to the tibia and articulates to both the tibia and talus to increase the mobility of the ankle.
Together, these three bones are connected via muscles and tendons to help stabilize the feet, control the joints, so they’re all essential for actions like running.
Symptoms of Ankle Pain While Running
Ankle pain comes in a variety of ways, as there is a wide range of reasons for your ankle to hurt you while or after you run. (more about that in the following section)
Some of these symptoms are more likely to happen than others, and you may feel one or more of these symptoms. Here are some of the most common symptoms of ankle pain while running:
- Dull or constant aching while standing or slowing down develops into a sharp pain in the back, front, or either side of the ankle
- Compromised ability to walk in a natural gait and running in an awkward way
- Instability while running and increased chances of tripping and falling
- Slight tenderness after running with a mild bruising and/or swelling
- Pinching and stiffness in the muscles around the ankle joint
7 Reasons: Why Do My Ankles Hurt When I Run?
Now that you know more about your ankle and the symptoms of pain in your ankles, here’s a brief look at some of the most common ankle injuries and the type of symptoms you should expect after them:
1. Ankle Sprain
Ankle sprains are by far the most common condition that causes ankle pain, especially during running.
This one usually occurs when you make a sudden incorrect move that results in twisting or turning your ligament the wrong way, which is the fibrous tissue responsible for stabilizing the bones and connecting them with each other.
As you can see, the onset of this injury is usually due to a single trauma or a direct running injury, so they’re pretty easy to figure out.
In this injury, the ligament is usually overstretched or torn depending on the severity of the twist, but luckily, it’s one of the most treatable injuries too.
In fact, if the misstep was a mild one, the stretch or the tear might be so tiny that you’re able to continue running afterward, although it’s always recommended to avoid running after a mild sprain, so you don’t add up to your small injury.
2. Ankle Strain
The ankle strain is quite similar to the sprain, with some minor differences. For instance, while sprains occur due to stretched ligaments, strains are caused due to any sudden move or roll that end up injuring the tendon.
The tendons are also fibrous connective tissue, but they’re responsible for coordinating the mechanical force between muscles and bones.
Like sprains, ankle strains are also extremely common but are very easy to tend to and should go away on their own.
Keep in mind that the tendons of the ankle may sometimes become inflamed due to repetitive use, even if you didn’t accidentally misstep or roll your ankles, more about it in the Tendonitis section.
3. Ankle Stress Fracture
A stress fracture is a common foot injury that affects most weight bearing bones of the leg. When the muscles around these bones are exposed to repetitive impacts that they can’t absorb properly, the bones start to develop tiny cracks within the bones due to overstressing the bones.
The simplest form of a stress fracture is shin splints, although they can also affect the ankles of marathon runners. Unlike ankle sprains and strains, stress fractures require medical attention to avoid developing into full fractures.
The symptoms of a stress fracture in the ankles include bruising, sharp pain, and tenderness. Since these symptoms are shared with other injuries, the most reliable way to diagnose stress fracture is through X-ray imaging, where they appear as tiny dark hairs on the edges of the ankle and heel bones.
Stress fractures heal on their own, provided that you stop running and provide your feet with proper care and any supportive medications prescribed by the doctor. They usually take anywhere between 1 to 1.5 months to heal.
4. Ankle Tendonitis
As previously mentioned, tendons can be overstretched and torn due to running awkwardly or misstepping. However, it can also happen due to inflammation or irritation of the tendons themselves, which is medically known as “tendonitis”.
Unlike direct injuries to the tendons, tendonitis is usually the result of overworking your ankle while running, whether it’s due to excessive running or slight errors in your techniques that add up with time.
Since there are several tendons in the ankle area, tendonitis can be split into several types, including:
- Posterior Tibial Tendonitis
- Achilles Tendonitis
- Extensor Tendonitis
The symptoms of the three types are usually the same, which are mainly a dull aching pain in the inflamed tendon, along with some minor tenderness and swelling.
5. Ankle Fractures
Ankle fracture is one of the most severe injuries that a runner can experience. This condition happens if any of the three bones that make up the ankle region is broken.
Broken ankles are mostly caused by heavy collisions and impacts to the ankle but can also occur as a result of tripping and falling while landing on the ankles.
Ankle fractures are usually accompanied by a cracking or grinding sound of the bones, followed by immense pain, swelling, heavy bruising, and inability to stand on your injured foot.
Sometimes, depending on the severity of the fracture, bleeding due to piercing of the bones and crooked appearance of the leg may also occur.
Ankle fracture is a serious ankle injury and requires immediate medical attention. A doctor will use radiation for imaging and may recommend corrective surgeries before wearing an ankle brace and cast along with crutches for a few weeks to months.
6. Ankle Arthritis
Although arthritis is significantly more common among older people, it can still affect athletes, and especially runners, of all ages.
Another misconception about arthritis is that they’re all the same. However, there are three different types of food arthritis, including:
- Rheumatoid arthritis
- Post-traumatic arthritis
All three of them are capable of causing pain in the ankles by weakening and damaging the joints in that area, which reduces mobility and makes running painful.
While there’s no definitive cure for arthritis, early diagnosis of the condition and using osteoarthritis treatments can help in slowing down its progression. These treatments include:
- Some medications
- Changes in lifestyle
7. Chronic Ankle Instability
Another reason that a lot of runners overlook is the instability of the ankle due to natural or biological limitations of the runner.
This happens when you have naturally weak ankles that tend to wobble while running. Repeating this motion excessively with time causes chronic pain and possible injuries while running.
If you have weak ankles, the ankle bone will overpronate and roll inwards on each step, which compromises the ability of the feet to absorb shocks while running.
While this pain starts out mild, it starts to gradually increase if you’re used to tracking long mileage with weak feet, reaching unbearable levels that will eventually interrupt your ability to go further.
One of the best solutions to this problem is strengthening the muscles around your feet and ankles using ankle exercises, such as heel raises and heel rolls.
Yet, you should check with a doctor to make sure there are no medical issues weakening the muscles of your feet.
Conditions and Situations That Can Worsen Your Ankle Pain While Running
In addition to all the previously mentioned ankle injuries that can cause some degree of ankle pain, there are some health conditions and situations that can contribute to worsening the pain. In this section, we’ll have a quick look at each one of them:
1. Flat Feet
Flat feet are among the most common foot deformities out there, with up to 25% to 30% of all the U.S. population suffering from the condition.
While all babies are born with flat feet, some people’s feet remain flat for the rest of their lives. If you have flat feet, it means that you lack an arch in your soles while standing, even if you can see the arch when you lift your foot up.
This type of flat feet is called “flexible flat feet”, where the arch isn’t strong enough to support the weight of your body while standing. Other types of flat feet are attributed to the tendons and being naturally tight, such as the Achilles tendon and the posterior tibial tendon.
The problem with flat feet varies depending on your activity level and the severity of the condition.
But, since it affects the way you run, it increases the chance of misstepping, which leads to various injuries that can cause ankle pain, such as sprains, tendonitis, and stress fracture.
2. Plantar Fasciitis
The bones of your heel, ankle, and toes, are all connected by a large band of connective tissues that are called “the plantar fascia”.
Plantar fasciitis is a condition where this band of connective tissue gets inflamed, producing a noticeable stabbing pain throughout the heel and the bottom of the ankle, especially when you wake up in the morning and while putting the ankle through lots of stress, such as running.
That’s why doctors usually recommend plantar fasciitis patients to avoid running until their feet heal completely.
3. Blisters, Corns, or Calluses
Blisters and calluses are caused by extensive friction between the skin of the feet, especially your big toe, heels, and ankles with the socks, shoes, or other surfaces they’re in contact with.
Corns are similar to calluses but they’re smaller with a harder part in the center that presses against the skin, and some of them are caused due to infections.
While these conditions won’t make your ankle hurt directly, running while having any of them in your feet can result in inadequate form or posture, which eventually leads to ankle and heel pain.
4. Using the Wrong Footwear
Not all shoes are created equal. Even if you have the best form and running technique, running with the wrong type of shoes can cause anything from arch pain to ankle and knee pain.
If you noticed that your regular running form is compromised in the shoes you’re wearing, you might want to opt for some suitable running shoes instead.
A shoe that is good for running will usually offer a lot of padding and support around the ankle and heel area along with excellent traction and flexibility at the joint spots of your feet.
There are plenty of awesome running shoes on the market that is designed to minimize the stress on your ankles, such as:
5. Your Running Shoe Is in a Bad Condition
No matter how sturdy your running shoes were when you bought them, after continuous use, they’re bound to wear off.
Using your worn-out running shoes while running long distances or at high speeds can increase the risk of tripping or developing an ankle injury because these shoes lost their arch support and anti-slip tread pattern.
As a rule of thumb, the lifespan of a good quality running shoe is anywhere between 250 and 350 miles, which are usually equivalent to 6 months of consistent use twice to 3 times a week.
So, if your ankle started to hurt you around that time, it’s time to buy a new pair to keep your ankle properly supported.
Common Treatments to Relief Ankle Pain While Running
Luckily, there are plenty of ways to treat or relieve ankle pain that is triggered while running, and most of them are non-invasive methods! Let’s check them out:
1. R.I.C.E Protocol
The golden standard and first-line treatment of most ankle pain problems is the R.I.C.E protocol. The popular and highly effective method includes:
- Rest: In which you try to put as little stress on the ankle as possible
- Ice: Apply an ice pack over the injured joint for 15 to 20 minutes, twice a day
- Compression: Use compression bands to apply mild compression on the area to reduce inflammation and swelling
- Elevation: Keep the sore ankle elevated above the level of your heart to improve blood flow to and from the ankles for quicker tissue healing.
This one is an acronym for “Non Steroidal Anti-Inflammatory Drugs”, which are over the counter medications that are used as painkillers and systemic treatments to reduce swelling and inflammation caused by the injury.
They’re usually taken around 2 to 3 times a day during the healing process, but you might want to avoid overusing them to prevent any unwanted side effects, such as gastric ulcers.
3. Physical Therapy
Physical therapy includes a variety of exercises that can help you strengthen the muscles around your ankle and recover sore muscles in the region.
Such exercises are usually done by a certified therapist, but they can also teach you how to perform them yourself.
These exercises are only used in mild ankle pain and not in severe ones, unless recommended otherwise by your doctor.
4. Supporting Braces
Limiting the range of motion of your ankle is a great way to speed up the natural healing process.
This method is used as an effective treatment in the case of stress fractures and chronic ankle instability, in which you wear a protective or a supportive shoe, wrap, or brace to keep your joints stabilized.
5. Corticosteroid Injection
When all else fails, your doctor may prescribe corticosteroids, which are usually in the form of an injection that has an extensive ability to reduce inflammations caused by joint injuries.
Additionally, they’re potent one-time treatment that is found to be effective against a wide range of conditions, such as Achilles tendinitis, rheumatic arthritis, and other conditions.
When Should You Visit a Doctor?
Of course, you can seek the help of a certified medical professional at any time that you suspect any pain in your ankles.
However, in the case of mild ankle pain, following simple treatments, such as R.I.C.E protocols and using NSAIDs as well as taking a break from running for a few days can be more than enough to solve the problem.
However, if the problem persists, or you’ve developed a sudden injury that may require ankle surgery or immediate medical attention, you should visit a doctor as soon as possible and avoid trying any treatments on your own.
Things to Keep in Mind Regarding Pain in the Ankles
Lastly, there are some additional points that you need to keep in mind regarding ankle pain while running.
- Always take your time and consider warming up before starting a long run to avoid any unpleasant incident, such as muscle cramps or form problems that may lead to an ankle injury.
- Avoid running on an existing ankle injury no matter how mild it is because it can end up causing another injury that is far more severe to the point that you may not be able to run for a few months
- Sports tape is a great solution for compression and overcoming minor pain, but you shouldn’t count on it as a long term solution to ankle problems.
- Consider trying out some balance training to improve your stability while running, as losing balance is one of the leading causes of ankle injuries.
- Always have a quick check of the place you’re running and avoid going on a run in a place with uneven terrain to avoid accidents.
- Incorporate ankle care in your post-running routine to speed up your recovery
With that said, you now have a brief answer to the popular question “why do my ankles hurt when I run?”.
As you can see, there are several culprits to the pain, but one thing you should know about foot pain and having a foot injury is quite frequent within runners. According to a study by Yale Medicine, up to 50% of all runners might get at least one injury in the lower leg every year.
Luckily, most of these injuries are not necessarily serious and are usually self limited, so they’ll resolve on their own without leaving any long-term effect as long as you rest and follow the R.I.C.E protocol or other recommendations by your doctor.