Running provides numerous health benefits. However, it can also put a lot of stress on the body, particularly the ankles. Due to various factors, ankle pain when running has become prevalent, with some estimates stating it accounts for up to 13.7% of running injuries.

This is because ankles are crucial in running, absorbing impact, and stabilizing the foot strike. Therefore, they are vulnerable to overuse injuries and strains. Over time, this overuse may flare up to acute injuries like sprains, or chronic ones, resulting in pain. 

However, identifying the underlying cause is vital in treating ankle pain properly. In this article, we will explore the common causes of ankle pain in runners, as well as prevention and relief strategies.

Common Causes of Ankle Pain While Running

Ankle pain can be in various forms, from a dull ache to a sharp, debilitating pain. However, understanding the causes of ankle pain can give a good idea of how to treat or prevent it in the first place.

Here are some of what may cause it:

1. Muscle Strains, Sprains, and Tears

Soft tissue injuries such as strains and sprains are common among runners. They occur when the muscles or ligaments in the ankle are overstretched or torn. 

Precisely, a strain is when the muscle fibers stretch beyond their limits, while a sprain concerns the ligaments. Tears, on the other hand, are more severe and can result from intense force or trauma.

Any of them can happen due to sudden movements, such as twisting or turning the ankle, or from repetitive stress on the muscles and ligaments. For instance, landing incorrectly after a jump, misstepping on a rocky trail, or suddenly changing direction can lead to ankle pain. 

2. Overuse and Overtraining

Another common cause of ankle pain in runners is overuse and overtraining. Running puts a lot of stress on the body, and if you don’t allow enough time for rest and recovery, it can lead to injuries. 

For example, in a survey of over 360 youth athletes with pain, about 45% were due to overuse. Running great distances daily or pushing past one’s limits without proper conditioning can cause issues such as tendinitis, stress fractures, or ankle joint inflammation. 

Also, overtraining can cause muscle imbalances and weaknesses, increasing your risk of ankle pain.

3. Improper Footwear

The type of shoes you wear while running can also contribute to ankle pain. Wearing the wrong ones for your gait and foot type can alter alignment and landing, overworking the ankles. Also, insufficient cushioning can transmit excessive ground impact to the joints.

Additionally, if your shoes lack a proper arch, it can lead to your ankle turning inward, which can disrupt weight distribution and cause ankle pain. So, choosing shoes designed for running and fit properly is essential.

4. Previous Injuries and Flare-ups

If you have a history of ankle injuries, you may be more susceptible to experiencing ankle pain while running. This is because past injuries can re-emerge as pain sources if not healed properly. 

Additionally, scar tissue or improper alignment post-injury can cause recurrent pain episodes. That’s why it’s crucial to properly rehabilitate any previous injuries before returning to running.

Read more: Cross-training for marathon

Preventing and Managing Ankle Pain

ankle pain recovery

With the right knowledge, Ankle pain is entirely preventable and manageable. Here are some things tips for the prevention of ankle injuries. 

1. Choose the Right Footwear

As mentioned, poor shoe choice commonly precipitates ankle pain. You can visit a specialty running store for a gait analysis to identify your arch type, pronation, and ideal shoes. 

This analysis lets you assess in slow-motion video replay how your feet respond when testing different shoes on the treadmill.

Moreover, as a rule of thumb, replacing your running shoes every 300-500 miles is safe. This is because the insole(s) may no longer offer the initial support and cushioning as it was when it was new, leading to potential foot injuries, ankle and knee problems, etc.

2. Gradual Training Progression

Another way to prevent ankle pain is gradually increasing your training intensity and volume. Generally, you should increase weekly mileage, distance, and power by at most 10% per week to avoid overloading tissue.

For instance, if you are running 40 miles and want to add to your mileage, you should only run 4 more miles weekly to stay safe. Also, ensure you build endurance and strength over several months when preparing for a half or full marathon

Additionally, consider taking rest days for recovery from ankle pain. This allows your body to adapt to the stress of running and reduces your risk of injury. In short, always listen to your body and not push yourself too hard too soon.

3. Warm-up and Stretching

A proper warm-up increases blood flow to the muscles and prepares them for exercise. You can try ankle circles, alphabet writing, heel raises, and leans to enhance your range of motion.

In addition, dynamic stretches, like leg swings or ankle circles, can prepare your body for a run. Conversely, stretching after running can also help reduce muscle tightness and improve flexibility.

4. Strengthening Exercises

Incorporating strengthening exercises into your training routine can also help prevent ankle pain. These exercises target the muscles that support the ankle joint, helping to reduce your risk of injury. Strong lower leg and ankle muscles enable you to stabilize landings and propulsion better. 

You can try resistance training 2-3 times per week, targeting all muscle groups around the ankle. And you can also use resistance bands, weight machines, and bodyweight exercises like lunges and hops. Overall, ankle strengthening exercises improve your running form and ankle health.

Read more: Can you run a marathon without training?

Relief and Recovery Strategies

Sports therapists have long endorsed the RICE method (Rest, Ice, Compression, Elevation). It is a simple and effective way to treat ankle pain in the acute injury phase. 

Here is a brief overview of each component.

1. Rest

Rest and limit activity on the injured ankle to allow it to heal. This means you must avoid any activities that cause pain. To do this, you can use crutches to prevent bearing weight on the ankle.

2. Ice 

Applying ice packs to the injured ankle can help minimize pain and swelling. As a rule of thumb, you should ice for 15-20 minutes every 1-2 hours for the first 48 hours after injury or after activity. Also, you can use an ice pack wrapped in a thin towel.

3. Compression 

Wrapping the ankle snugly with an elastic bandage provides gentle compression, minimizing swelling and providing support. However, you must be careful not to wrap too tightly. Elevate the ankle above heart level when applying compression.

4. Elevation 

Keeping the ankle elevated above the heart level helps reduce swelling by allowing fluid to drain away from the ankle. You can use pillows to prop the ankle up on a bed, couch, or chair. You should also avoid letting the ankle hang down when sitting.

5. Pain Management

This is not part of the RICE method but is also essential to your recovery if all else fails. Over-the-counter nonsteroidal anti-inflammatories like ibuprofen can help ease ankle pain and inflammation. So, you can always have some in handy. Plus, you can apply menthol gels to get a cooling effect. 

However, it’s important not to rely on these medications for long-term pain management. See a doctor for prescription medication or cortisone injections for severe cases.

Final Thoughts

Running is a high-impact activity that commonly produces ankle pain. However, with a few preventive measures, ankle injuries in runners are largely avoidable. Wear proper footwear for your foot type, follow sensible training routines, and strengthen muscles proactively. 

You can also manage acute ankle pain diligently through RICE therapy, medication, and activity modification. However, ensure you see a physical therapist or sports medicine doctor for an accurate diagnosis and customized rehabilitation program. 

With some care and patience, ankle pain generally resolves within several weeks to months, allowing a safe return to pain-free running.

Ankle Pain FAQs (Frequently Asked Questions)

1. Is it normal for your ankles to hurt while running?

It is common for runners to experience some discomfort in their ankles while running. However, if you are experiencing persistent or severe pain in your ankles while running, it may indicate an underlying issue.

2. Does running damage ankles?

Running itself does not damage ankles; however, improper training techniques or overuse can lead to injuries that may cause damage.

3. What is a runner’s ankle?

Runner’s ankle is a term used to describe various conditions that affect runners’ ankles, including sprains, strains, tendonitis, and stress fractures.

4. How do I strengthen my ankles for running?

You can do several exercises to strengthen your ankles for running, including calf raises, heel walks, toe walks, and balance exercises.

5. How to reduce ankle pain while running?

To reduce ankle pain while running, wear proper footwear, gradually increase your training intensity and volume, warm up before running, stretch after running, incorporate strengthening exercises into your routine, and allow for adequate rest and recovery.

6. What causes outer ankle pain after running?

Various factors, including muscle strains, sprains, and tears, overuse and overtraining, improper footwear, and previous injuries, can cause outer ankle pain after running. 

You should consult with a healthcare professional if you are experiencing persistent or severe outer ankle pain after running.