Why does my ankle hurt when I run?

Ankle pain is a common problem for triathletes. Physio Diarmaid Donohoe explains what causes ankle pain when running – and how you can treat it or, better still, prevent it…

Why does my ankle hurt when running

Ankle pain can result from damage to multiple different structures, and can be divided into an acute ankle injury (sprains) or a chronic (overuse) injury. Typically, long-distance running can lead to overuse injuries. The most common run-related overuse injuries that cause ankle pain involve the following structures: tendons, ligaments and bony stress injuries.


What are the symptoms of an overuse ankle injury?

When tendons are involved, pain usually starts a few hours after a run. This can develop into pain during running, which can progressively worsen until the triathlete’s forced to stop running. Pain at the back of the ankle is often associated with an Achilles tendon injury. Rest usually eases symptoms but does little to provide a long-term solution.

With bony stress fractures, lateral ankle pain can kick in as soon as running commences and can be more pronounced when running on trails or rocky surfaces. Triathletes enduring this type of pain will usually have a history of rolling their ankle.

What causes an ankle injury?

Generally, a large spike in training load is the number one trigger for overuse ankle injuries. Triathletes who rapidly increase their weekly run training volume are most susceptible with these injuries often arising at the beginning of a season or after a long lay-off; in short, when the triathlete goes from “0 to 100”, causing the tissues to become overloaded. Other risk factors include injury history, changes in footwear, changes in training – for example, adding high-intensity intervals – and changes in running surfaces – for example, hitting the jutted trails for the first time.

What is the treatment for an ankle injury?

You should discuss reducing your total running mileage with your physio. It’s not necessary to completely stop running, but a reduction in total running volume will often likely be needed in order to settle down the irritated area. This will vary massively depending on the triathlete. A structured rehab programme is essential in the treatment of ankle injuries, too. This must include strength-focused exercises, and single leg balance and control movements. If a bony stress injury is involved, a period of rest from running will be needed and the triathlete should up the less-debilitating swimming.

How can you prevent ankle injuries?

A graded progressive training programme with sufficient recovery days each week is paramount to prevent injury. Recovery weeks are important and can be scheduled in between race weeks. Strength and conditioning programmes MUST be undertaken by all triathletes and included in their weekly training. This is vital for reducing injury.

S&C sessions can be paired with light running sessions or they can be done on non-running days. Twice a week is ideal. Simple home exercises, including calf raises, split squats and single leg deadlifts, will strengthen your legs and lower the chances of injury. Slowly increasing some form of weight will keep the tissues resilient against future injury. Finally, apps such as Strava are a great way to analyse weekly running volumes and prevent potential injury.

Like with any health issue, if you have any concerns at all, seek medical advice from a qualified medical practitioner, whether that’s a doctor or physiotherapist. 

Diarmaid Donohoe is a physiotherapist with Six Physio Fitzrovia. He has worked for elite-level GAA football in Ireland and at the Sports Surgery Clinic Dublin, and currently works part-time as an Academy Physiotherapist with Fulham FC. He is also a certified strength and conditioning specialist with the NSCA.