The 6 Most Common Reasons for Ankle Pain while Running

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 Tendon Runner

ACHILLES TENDONITIS

  • 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 Running

How can you rehab Achilles Tendonitis?

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.

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

What kinds of treatments can be done for Achilles Tendonitis?

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
Achilles Tendonitis stretch

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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.

How can you rehab Anterior Shin Splints?

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.

What kinds of treatments can be done for Anterior Shin Splints?

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
  • PRICE therapy
  • Running gait training

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.

I have supplied a link to the bands for your convenience on my resource page.

What kinds of treatments can be done for Ankle Impingement?

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
Anterior Ankle Impingement

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?

How can you rehab Chronic Ankle Instability?

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.

What kinds of treatments can be done for Chronic Ankle Instability?

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

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.

What causes Tarsal Tunnel Syndrome?

What causes the compression of the nerve in the first place?

Tendon swelling, arthritis, and pronation of the foot are all things that can relatively decrease the size of the tunnel.

All we need is for the nerve to be able to slide freely through this tunnel.

I marked the tunnel in this picture to assist but the nerve is not shown.

Tarsal Tunnel Running

How can you rehab Tarsal Tunnel Syndrome?

Standard ankle and foot rehab can assist in normalizing mechanics of the area, but without normalizing the size of the tunnel, the condition will not improve.

Standard ankle/foot protocols we use are:

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

What kinds of treatments can be done for Tarsal Tunnel Syndrome?

  • Active Release Technique
  • Deep tissue massage
  • Band assisted ankle mobilization
  • Anti-inflammatory injections
  • Prolotherapy
  • Chiropractic adjustments or mobilizations
Tarsal Tunnel Running

PERONEAL TENDONITIS

  • Pain on the outside of the foot?
  • Behind the anklebone?
  • Does the bone on the outer side of your foot feel broken?

This is one injury I’ve personally had. Every step was like murder, but when I put on my cycling shoes to ride, it was all fine!

Odd, huh?

This is Peroneal Tendonitis.

If you think you have this, please don’t suffer through it. It will not be fun and it could last months unless you rehab it.

Peroneal Tendonitis Running

What is Peroneal Tendonitis?

Peroneal Tendonitis is when the tendon has become damaged from microscopic tearing.

The tearing creates an inflammatory response and pain comes along with it.

Pain is only one of the 5 pillars inflammation and the one we should care the least about.

What causes Peroneal Tendonitis?

Peroneal Tendonitis starts at the trunk.

That’s right. The trunk.

Poor core strength leads to improve landing mechanics via internal femoral rotation.

Internal femoral rotation occurs when the glutes are not functioning well.

What is Peroneal Tendonitis?

Peroneal Tendonitis is when the tendon has become damaged from microscopic tearing.

The tearing creates an inflammatory response and pain comes along with it.

Pain is only one of the 5 pillars inflammation and the one we should care the least about.

What causes Peroneal Tendonitis?

Peroneal Tendonitis starts at the trunk.

That’s right. The trunk.

Poor core strength leads to improve landing mechanics via internal femoral rotation.

Internal femoral rotation occurs when the glutes are not functioning well.

What kinds of treatments can be done for Peroneal Tendonitis?

Because the injury can be very painful, often, we have to reduce the pain for full rehab.

These treatments are therefore needed early in the condition.

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

ANKLE LIGAMENT SPRAIN

Chronic groin pain typically happens over time, which is why with sports hernias, we do not hear many stories of feeling a “pop” or a specific moment of injury.

It is thought to be the result of “overuse” mechanics stemming from a combination of poor strength and endurance, lack of dynamic control, movement pattern abnormalities and discoordination of motion in the groin area.

There is a lot going on in the groin area. There are lot of muscles, tendons and fascia pulling in different directions. These contracting structures need to coordinate together for any athletic motion. This is also known as the injury prevention model.

Chronic groin pain typically happens over time, which is why with sports hernias, we do not hear many stories of feeling a “pop” or a specific moment of injury.

It is thought to be the result of “overuse” mechanics stemming from a combination of poor strength and endurance, lack of dynamic control, movement pattern abnormalities and discoordination of motion in the groin area.

There is a lot going on in the groin area. There are lot of muscles, tendons and fascia pulling in different directions. These contracting structures need to coordinate together for any athletic motion. This is also known as the injury prevention model.

Peroneal Tendonitis

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