Inside/medial ankle pain: causes, treatment and how to prevent it

The ankle joint is a fabulous structure, an intricate joint that plays a crucial role in our lower limb function. But when pain strikes it can quickly derail our training plans and race goals.

So here’s everything you need to know about inner ankle pain: what causes it, how to treat it and, most helpfully, how to prevent it.

What causes pain on inner side of ankle?

Inner ankle pain (known medically as medial ankle pain) can be caused by an array of problems, however in triathlon, most are usually due to an overuse type injury, or some sort of trauma, for example, sustaining an ankle sprain.

With the instances of medial ankle sprains being quite low, most inner ankle pain is that of a progressive nature, with those not really being able to relate it to a specific injury.

Things that can contribute to the cause of inner ankle pain can be:

Inappropriate footwear

The wrong type of trainers can cause pain, especially in running. Make sure you select a pair that fit correctly and offer the right amount of support for your foot and ankle.

Previous ankle injuries

Substantial evidence has suggested that having a previous ankle sprain increases your chances of having further injuries or conditions related to the foot and ankle.

Doing too much too soon

Research shows us that, even an increase of 10% or above in your training can increase your chance of injury (R O Nielsen et al 2014).

Reduced strength, flexibility, and balance

While running you are always on one leg, therefore your single-leg strength, stability and mobility have to be good to help to prevent you from injury.

What are the symptoms of inner ankle pain?

The symptoms of inner ankle pain can vary dependant on the type of injury you have, however it most commonly could include:

• A dull ache or burning pain around the inside of the ankle or arch of the foot.
• Localised swelling.
• Tenderness to touch.
• Tingling sensation or numbness feeling in the area.
• Muscle weakness in the lower leg.
• A flattening of the arch of the foot.

How do you get rid of an inner ankle pain?

Firstly, to improve the injury, it would be advisable to stop any aggravating activity.

If it is an acute injury (an injury that comes on quickly) then using a cold compress for 5-10 minutes on the area, 3-4 times per day, may help to treat any local inflammation. I would suggest doing this for the first 3-4 days.

You can also use an ankle support in the first few days of a rest period from exercise, however, be mindful to try and keep normal movement as much as possible.

If the pain should return during your next training session, then stop and seek further advice from a physiotherapist.

Other things that may help you to get rid of the ankle pain include:

• Reflecting on training; has training recently increased in pace or distance? If so, this could be the reason why it started, and you should return to a pace or distance that you were comfortable with previously to see if symptoms still occur.
• Start with some isometric strengthening exercises for your foot and ankle. This will help with the remodelling and repair of tendons. An example of this would be placing your hand on the inside of your foot, press resistance against your hand and hold this resistance movement for the count of 10 seconds and repeat 8 times. You can then repeat this for 2 or 3 sets, depending on how tolerable the pain is.

What can cause inside ankle pain without injury?

Pain that starts without injury or trauma is normally progressive in nature, which means an injury has started due to repeated stress or strain to a particular part of the body.

Three possible causes for inner ankle pain are:

• Distal tibial stress fracture – This is a type of fracture in the lower leg that is normally due to repeated strain or activity.
• Posterior tibialis tendinopathy – This is inflammation of the tendon that sits around the inner part of the ankle.
• Tarsal tunnel syndrome – This is compression or irritation of the tibial nerve as it travels under a tendon sheath.

How can you prevent inner ankle pain?

Unfortunately, there are no tricks to entirely prevent injuries, however, there are many things that you do to help reduce the chance of it happening.

Some tips for this are:

• Making sure your trainers are a good fit and support your foot and ankle well.
• Condition your lower limbs by adding in some strength and flexibility training to your plan.
• Warming up well before you start your exercise.
• If you start to develop a pain during your training or exercise, do not push through it. Stop and seek some medical advice.
• Lastly, when you return to exercise, make sure you do this gradually, by increasing pace, distance and intensity slowly overtime.

How do you treat tendonitis in the inner ankle?

Tendonitis or tendinopathy is a common injury that can occur with either repetitive stress to a tendon or when a tendon has a small injury due to a sudden change or increase in activity.

Tendons can be slow to heal and can cause problems with pain and dysfunction, occasionally for many months. However, the good news is that if treatment is started quickly, it is likely that it makes a good recovery.

The tendon most affected by this in the inner ankle, is the ‘posterior tibialis’ tendon. This condition can cause pain and tenderness around the inside of your ankle and along the arch of your foot. You might find it difficult to push up with the foot or tip toe.

To start treatment for this condition, you must firstly try and manage the weight through the tendon differently. In some instances, complete rest from aggravating activities may be required for a period of some days or weeks.

This will help to get the pain under control so you can start some rehabilitation.

Self-treatment at home should be based around strengthening exercises for the muscles around the foot and ankle, and broken down into isometric, eccentric and concentric exercises.

Seeing a physiotherapist to help advise you of rest periods and exercises would be a great way in which to manage this condition best.

Top image credit: Getty Images