Maintaining an active lifestyle means listening to your body and being aware of what pain signals mean and when to take action. For runners asking “why do my ankles hurt when I run,” this niggling pain may be a harmless side effect of their exercise regime, or could signal a deeper issue that should be checked out.
In this ‘pain, explained’ article we’ll be taking a look at some of the key reasons you might feel ankle pain when running, as well as a few other lifestyle factors that can cause ankle pain to flare up.
Ankle pain when running – causes and solutions
The ankle is a large, complicated collection of joints, ligaments and muscles that helps to bear and distribute our weight evenly throughout our foot, provides flexion both upwards (proximally) and downwards (distally). The ankle also directs force in the human gait, helping us stand, walk and run.
Three bones, the tibia, fibula and talus make up the bony structure of the ankle, while several strong ligaments help support this structure. This includes the deltoid ligament, a triangular-shaped band that connects the tibia to the navicular, the calcaneus and the talus.
The ankle and its structures, being load bearing, are particularly prone to stress and injury. This is especially the case in physically active individuals, those who work physically demanding jobs or older people. In fact, the ankle is the most commonly injured major joint in the body.
Running is one of those exercises considered ‘high impact’. High-impact simply means any exercise that requires both feet to come off the ground at the same time. Skipping with a rope and jumping exercises are other examples of high-impact workouts, whereas swimming and cycling are ‘low-impact’.
Running involves a lot of jolting movements that impart force into our bones and joints when our feet make contact with the ground. While these exercises are often great for building muscle strength and burning calories, they do come with a higher risk of injury and strain – with the ankles potentially bearing the brunt.
Why do my ankles hurt when I run?
Ankles can be prone to stresses and strains, and it’s often while running or participating in other high-impact activities that these present as ankle pain. If you experience ankle pain when running, it’s important to rule out any injury that could be exacerbated by running before looking at other potential causes.
Pain in the ankle that is accompanied by any of the following symptoms is a decent indicator of an injury:
- Bruising or discolouration of the area or its surroundings
- Pain that’s more intense when weight is applied
- A lower range of motion, such as when you tilt your foot up or down
- The area is swollen and tender, and may feel hot to the touch
- Instability or the feeling that the ankle may ‘give out’.
While our guide might help you answer the question “why do my ankles hurt when I run,” there’s no substitute for having your ankles checked by a GP or physio if you are in any way concerned. If you suspect your ankle is broken, the pain is intense, your can’t place weight on the area at all and you have any fever, it’s important to seek medical attention as soon as possible.
Let’s go through a few of the most common ankle pain causes and solutions below:
Too much running!
This one might seem obvious, but it’s common for athletes and physically active people to push through physical pain to keep up with their exercise regime. Sore ankles may just be a sign that you’ve overdone it – excessive use can make the tendons and muscles in your ankle inflamed. If this excessive use continues, this could progress into:
Ankle tendonitis
The ankle relies on a number of tendons that can become frayed, inflamed and damaged by repetitive movements. This can happen with excessive use, if your running form and posture doesn’t support you properly, or if your shoes don’t support your foot well, causing you to impact the ground at an angle that puts more strain on your legs and ankles. Tendonitis can’t always be prevented, but taking the time to warm up gently before any high-impact exercise can help. Ankle tendonitis is best relieved by resting the affected area. This process can be slow depending on severity, so it’s best not to resume running until symptoms have completely gone. Acute tendon pain and inflammation can be treated with ice (always make sure to wrap your ice pack in a towel, never place directly on the skin,) or anti-inflammatory medication (NSAIDs.)
Ankle sprains and strains – ‘rolled ankles’
Sprains and strains are incredibly common ankle injuries, particularly so in runners. Sprains and strains often get bundled together, but it’s important to note that a sprain if when a ligament is injured, and a strain is when a tendon or muscle gets damaged, torn or overstretched. We’ve written about this in our hip pain ‘pain, explained’ article.
Unlike tendonitis, which is driven by overuse, sprains and strains tend to arise from damage or an injury to the area. A really common one is a ‘rolled ankle,’ which occurs when a mis-step causes the weight of the body to be forced onto the ankle structure instead of the plantar, or sole of the foot.
This can cause initial pain, with lingering effects depending on the severity of the injury. If you’ve rolled your ankle in the past and continue to experience ankle pain when running, then more recovery time and a lower impact exercise regime may be required while your ankle heals.
There’s no quick cure for a sprained ankle, only rest and time will help the affected ligament heal. Mild sprains might heal in about two weeks, whereas more severe sprains may still be painful in about three to six months time.
Initial swelling straight after the injury can be brought down using RICE, that is Rest, Ice, Compression and Elevation. Regularly icing the area for up to 20 minutes every 2 to 3 hours is advised for the first couple of days after sustaining the injury.
Arthritis
Arthritis can affect any joint in the body, the ankle and foot are no exception. Age related wear and tear, referred to as osteoarthritis, means that the cushioning layer of cartilage gets worn down, causing the bony structures of the ankle to rub painfully together.
Arthritis can cause inflammation in the joints, causing them and the nearby soft tissue to become painful, especially with activity. Osteoarthritis tends to develop slowly, making joints more stiff and painful over time. While it typically affects people past middle age, younger people can also be affected.
Unfortunately there is no cure for arthritis, but there are treatments, medications and lifestyle changes that can help slow its progression – your GP can discuss these with you. Arthritis doesn’t mean you have to give up on your exercise goals, but adjustments may be advised to help reduce the risk of damage to affected joints.
Acute pain may be best treated with painkillers such as NSAIDs, which have been proven to effective for pain related to osteoarthritis. Electrotherapy can also be useful for treating chronic or acute pain associated with arthritis, tendonitis, sprains and strains. Devices like BioWaveGO use electric waves to penetrate deep into tissue to provide immediate pain relief to the affected area, and are an effective, safe alternative to pain relief medication.
Relief for ankle pain from running
Getting to the source of your ankle pain will help you identify the best possible treatment, and as always this is best done under the supervision of a GP or physio.
How to get rid of ankle pain from running
For people who struggle to exercise or stay moving because of acute or chronic ankle pain, treatments aimed at making this pain more manageable or providing instant ankle pain relief may be suggested. This can include electrotherapy, which is when electrical waves are used to disrupt the pain signals travelling through the nerves and effectively block pain from reaching the brain.
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Sources
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- Proske U, Morgan DL. Muscle damage from eccentric exercise: mechanism, mechanical signs, adaptation and clinical applications. J Physiol. 2001 Dec 1;537(Pt 2):333-45. doi: 10.1111/j.1469-7793.2001.00333.x. PMID: 11731568; PMCID: PMC2278966.
- Olsen O, Sjøhaug M, van Beekvelt M, Mork PJ. The effect of warm-up and cool-down exercise on delayed onset muscle soreness in the quadriceps muscle: a randomized controlled trial. J Hum Kinet. 2012 Dec;35:59-68. doi: 10.2478/v10078-012-0079-4. Epub 2012 Dec 30. PMID: 23486850; PMCID: PMC3588693.
- Hegarty DA, Bretherton B. An Open-Label Pilot Study Investigating Noninvasive High-Frequency Peripheral Nerve Fiber Stimulation in Chronic Pain. Pain Pract. 2021 Jun;21(5):578-587. doi: 10.1111/papr.12993. Epub 2021 Jan 27. PMID: 33369130.
Read more:
Sources
-
- Proske U, Morgan DL. Muscle damage from eccentric exercise: mechanism, mechanical signs, adaptation and clinical applications. J Physiol. 2001 Dec 1;537(Pt 2):333-45. doi: 10.1111/j.1469-7793.2001.00333.x. PMID: 11731568; PMCID: PMC2278966.
- Olsen O, Sjøhaug M, van Beekvelt M, Mork PJ. The effect of warm-up and cool-down exercise on delayed onset muscle soreness in the quadriceps muscle: a randomized controlled trial. J Hum Kinet. 2012 Dec;35:59-68. doi: 10.2478/v10078-012-0079-4. Epub 2012 Dec 30. PMID: 23486850; PMCID: PMC3588693.
- Hegarty DA, Bretherton B. An Open-Label Pilot Study Investigating Noninvasive High-Frequency Peripheral Nerve Fiber Stimulation in Chronic Pain. Pain Pract. 2021 Jun;21(5):578-587. doi: 10.1111/papr.12993. Epub 2021 Jan 27. PMID: 33369130.
