How to Treat Inner Ankle Pain When Running or Walking?

Inner Ankle Pain Symptoms?

Sharp pains in your arch or inner ankle? Popping sensations? Sore to the touch? These are all signs you might have posterior tibial tendonitis!

Posterior tibial tendonitis is a common runner’s injury that can stop you in your tracks and make you wonder if you will ever run pain-free again. Never fear, though. We can help you can back on track, literally!

Causes:

The posterior tibial tendon is one of the most important tendons of the leg. This tendon attaches the calf muscle to the bones of the inside foot. The main function is to hold up the arch and support the foot while walking. An acute injury like a fall can tear the tendon or cause it to become inflamed. Once the tendon becomes damaged, the arch will slowly fall over time. This can cause pain along the inside of the foot or ankle, pain that worsens with activity, and pain outside the ankle due to compensation.

Inner Ankle Pain Home Treatment

• Resting your foot as much as possible to reduce pressure on the arch is a good strategy.
• Staying off your foot as much as possible and switching to swimming or bicycling to reduce foot pressure is also a good strategy.
• Icing your foot – you can use a freezer gel pack or a plastic bag with some ice wrapped in a cloth. Place it on your foot around your arch. You may need to use medical tape or tie a cloth around the ice pack to keep it in position on the foot.
• Anti-inflammatory medications include topical analgesic gel, Motrin, Advil, or Aleve by mouth to reduce swelling and pain.
• Once pain allows, do calf stretching and perform strengthening exercises for the tendon, such as a seated theraband with light resistance-type exercise.

Isn’t Home treatment working? We have several in-office ways to help you

Podiatrist Diagnosis:

I will do a physical examination to look for several signs of this condition, such as swelling, a change in the foot’s shape, toe layout, flexibility, and range of motion. X-ray, ultrasound, MRI, and CT scans may also be used to further evaluate the tendon and rule out a posterior tibial tendon tear.

Schedule an appointment with us in Michigan if you are not getting better!

“If you are inside of the ankle pain, inner ankle pain while running an inner ankle pain while walking is not can better after a month or 2, you need to see a podiatrist excavation point,” Says Michigan podiatrist Dr. Tom Biernacki DPM.

In Office Treatment

• Physical therapy is something I can write a prescription for if home stretches are not enough. Physical therapists offer rehabilitation exercises or other modalities to help the foot heal.
• I can also give steroid injections or prescribe stronger anti-inflammatory medication.
• Podiatry recommended orthotics – insoles for posterior tibial tendon problems should support the medial longitudinal arch.
• I may prescribe bracing or a CAM boot to keep the foot immobilized. A lace-up ankle brace may help mild to moderate flatfoot by supporting the joints of the back of the foot and taking tension off the tendon. A custom-molded leather brace is needed for the severe flat foot that is stiff or arthritic. The brace can help some patients avoid surgery.
• Additional treatment options, including surgery, may even be discussed

When can I return to running after inner ankle pain?

Posterior Tibial Tendonitis can cause permanent damage if not properly taken care of, so returning to running should be very gradual. If you think you may be experiencing symptoms of posterior tibial tendonitis, please schedule an appointment for an evaluation.

Possible Causes of Inner Ankle Pain When Walking or Running:

Overuse/chronic medial ankle pain: The following injuries are common causes of pain on the inside of the ankle, occurring gradually over time. They are often the result of overuse:

Tibialis posterior tendinopathy & tendonitis:

Tibialis posterior tendonitis – medial ankle pain

Tibialis posterior tendinopathy causes pain inside the ankle, under the medial malleolus (bony bit inside the ankle).

Symptoms include:

• Gradual onset pain is located under and behind the medial malleolus, on the inside of your ankle.
• Pain may also radiate under the arch of your foot.
• More on Tibialis posterior tendinopathy
• Flexor hallucis longus tendinopathy
• Flexor hallucis longus
• Flexor hallucis longus tendinopathy or flexor tendonitis is inflammation or degeneration of the flexor tendons in the foot. Symptoms include:

Flexor hallucis longus tendonitis:

• Pain on the inside of the ankle: Specifically, pain along the length of the tendon as it passes around the back of the medial malleolus and into the foot’s arch.

More of the Flexor hallucis longus tendon injury:

Medial calaneal nerve entrapment:

This is also known as Baxter’s nerve:

• Medial calcaneal nerve entrapment has similar symptoms to that of tarsal tunnel syndrome.
• You will feel a burning pain below the medial malleolus (bony bit on the inside of your ankle).
• Pain may radiate under the sole into the arch of your foot.
• Running usually aggravates the condition.
• You may also have tenderness over the medial malleolus.

More on medial calcaneal nerve entrapment

Tarsal Tunnel Syndrome:

Tarsal tunnel syndrome medial ankle pain

• Tarsal tunnel syndrome is caused by pressure on the posterior tibial nerve as it passes on the inside of the ankle. Symptoms consist of:
• Burning pain in your heel can radiate into your foot’s arch.
• The sole of your foot may feel numb, or you may experience pins and needles.

More on Tarsal Tunnel Syndrome

Talar stress fracture:

• The talus bone is the bone at the top of the ankle, where the tibia or shin bone sits. A stress fracture of the talus is a hairline crack in the bone caused by overuse.
• Symptoms are more likely to include gradual onset pain outside the ankle but may also be felt on the inside.
• Exercise will worsen symptoms, particularly running, and ease with rest.

More on Talar stress fracture

Medial malleolar stress fracture:

• The medial malleolus is the bony bit on the inside of the ankle. A stress fracture of the medial malleolus can occur but is very rare2.
• It causes pain on the inside of the ankle, which is exacerbated by activity, especially running and jumping.
• You will have specific point tenderness over the medial malleolus where the fracture is located.
• You may also be swelling, but not in all cases.
• If the stress fracture is in the early stages, it may not show up on an X-ray, but a bone scan, CT scan, or MRI can confirm the diagnosis.

More on Medial malleolar stress fracture.

Posterior ankle impingement:

Ankle impingement is when a bony growth at either the front or back of the ankle bone restricts normal ankle range of motion. Impingement means tissues have become trapped between bones.

Pain is usually felt at the back of the ankle but can radiate or manifest on the inside of the ankle.

There will be tenderness behind the bottom tip of the fibula bone.

Pain will most likely be worse at the end of the movement when the foot is pointed down into plantarflexion with the foot pointing downwards.

Going up onto tiptoes may be painful. An X-ray can show up any bony spurs on the talus (heel bone) and end of the tibia (shin bone).

More on Ankle impingement

Referred pain:

Pain on the inside of the ankle may be referred from injuries or conditions elsewhere in the body. For example, sciatic pain from the lower back can radiate down into the leg. Trapped nerves in the foot may also cause medial ankle pain.

More on referred pain and nerve pain.

Eversion ankle sprain:

Eversion ankle sprain

An eversion ankle sprain occurs when your ankle rolls inwards. It is much rarer than a normal ankle strain and is often accompanied by a fracture of the fibula bone.

More on Eversion ankle sprains

Ankle sprain

Sprained ankle

A conventional ankle sprain will likely cause most pain outside the ankle. However, bruising of the bone on the inside of the ankle can also occur from compression.

Navicular stress fracture:

Symptoms of a navicular stress fracture include a poorly localized ache in the midfoot, which worsens with exercise.

Pain may radiate along the inside arch of the foot and goes away quickly with rest, only to return as training resumes.

Tenderness may be felt when the thumb is pressed into the top of the foot over the navicular bone, called the N spot.

Read more on Navicular stress fracture.

References & further reading

Rolf C, Guntner P, Ekenman I et al. Dislocation of the posterior tibialis tendon: diagnosis and treatment. J Foot Ankle Surg 1997;36(1):63–5.

Brukner P, Bennell K, Matheson G. Stress Fractures. Melbourne: Blackwells Scientific Asia, 1999.