Ankle injuries are an unfortunate yet all too familiar reality of running, affecting runners of all levels and skill levels. While minor aches and pains may be normal, when they become persistent it’s essential that physical therapists assess them.
Running with ankle pain is difficult and can make your training less enjoyable. This article will help identify its source and offer solutions to treat it!
Posterior Tibial Tendinopathy
The posterior tibial tendon controls the inner arch of your foot. When weak or injured, this tendon can collapse your arch. When this occurs, symptoms include pain on the inside of ankle and foot as well as swelling, inward rolling of ankle, inward rolling of foot. Your doctor will perform a physical exam that includes moving ankle in different positions while asking you to raise up onto toes to check tendon health; they may even ask you to raise them up again!
Running and standing-related occupations pose an increased risk for tendon strain due to repetitive movement – particularly if they have flat feet.
Symptoms can be treated by rest, nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation, and physical therapy exercises that strengthen tendons. For severe cases, surgery may be required; this involves either removing inflamed tissue and cleaning out your tendon, or transplanting healthy fibers from another part of your body into it to replace damaged fibers.
Flexor Hallucis Longus Tendinopathy
The Flexor Hallucis Longus muscle is responsible for flexion of the big toe and can become irritated over time, leading to pain in the inner ankle area (figure 1). Ballet dancers frequently place their feet into an “en-point” position that puts extra strain on this tendon; excessively large shoes that force foot gripping onto ground can also strain this tendon as can overuse of this muscle.
The tendon passes through a fibroosseous tunnel behind the medial malleolus that is filled with synovial fluid. At times, its passage may be compromised due to an enlarged os trigonum that reduces space for it as it passes from posterior ankle joint into sustentaculum tali (figure 2).
This condition is characterized by pain in the inner ankle region that extends into the big toe, with symptoms worsening with activity or physical exertion. Treatment includes avoiding activities which worsen symptoms and beginning physiotherapy treatments designed to off-load tendon pain through strengthening exercises for feet and ankles, taping techniques, manual therapy techniques and exercise programs.
Retrocalcaneal Bursitis
If you are experiencing heel pain, Retrocalcaneal Bursitis could be to blame. A bursa is a fluid-filled sac filled with cushions or lubricants which acts as an intermediary when muscles and tendons slide across bone surfaces; most major joints include ankle bursae as a form of protection. Overuse or repetitive strain may irritate and inflame this bursa causing overuse injuries or bursitis to appear in its place.
The primary symptom is swelling at the back of the heel, often accompanied by tightness in both calf muscles and Achilles tendon. Discomfort increases when tip-toeing, running uphill or jumping.
Rest and ice packs may provide relief; your physiotherapist may use soft tissue techniques or joint mobilisation to soothe inflammation. In addition, medications like ibuprofen or naproxen may reduce swelling. In severe cases, corticosteroid injection into the retrocalcaneal bursa may provide additional support.
Achilles Tendinopathy
Achilles tendinopathy refers to pain that strikes the Achilles tendon where it attaches into the heel bone (calcaneus). It typically develops slowly over time and may be brought on by tight or fatigued calf muscles transferring too much load onto the Achilles tendon, increasing mileage or exercise intensity too quickly, or excessive hill running.
Your ankle may feel tender or tender to touch when touched, or have an unusual bump or lump when loaded in dorsiflexion – such as when walking, running or rising from a chair – which causes more pain. Wearing rigid or stiff shoes which don’t support the foot well could also exacerbate these symptoms.
Achilles tendinopathy symptoms typically improve with conservative management techniques such as ice, gentle massage, stretching exercises and strength and conditioning work. While symptoms may take up to one year to completely disappear, you should typically return to your regular activities without significant pain or injury.
