> ## Content Index > Fetch the complete content index at: https://www.thephysiohub.uk/llms.txt > Use this file to discover other available public pages before exploring further. # Ankle Injuries in Runners: Treatment, Recovery and Prevention - URL: https://www.thephysiohub.uk/ankle-injuries-in-runners/ - Published: 2026-08-28T11:17:46.000Z - Updated: 2026-08-28T11:17:46.000Z - Description: A practical, evidence-based guide to common ankle injuries in runners, including ankle sprains, Achilles pain and bone stress injuries, with advice on treatment, rehabilitation, returning to running and reducing future injury risk. - Author: Andy Hubbert - Tags: Running & Sport, Sport & Performance, Pain & Conditions Running places repeated demands on the muscles, tendons, joints and bones around the ankle. Most of the time, these tissues adapt to that load and become stronger. Problems can develop when the demands of running temporarily exceed what a particular tissue can tolerate. Sometimes this happens suddenly — such as rolling your ankle on a kerb or trail — while other problems build gradually over several weeks. The good news is that **most running-related ankle problems can be successfully managed without surgery**, and complete rest is often not the answer. The important part is working out **what structure is causing the problem and how it should be loaded during recovery**. ![man in black shorts running on gray asphalt road during daytime](https://images.unsplash.com/photo-1581889470536-467bdbe30cd0?crop=entropy&cs=tinysrgb&fit=max&fm=jpg&ixid=M3wxMTc3M3wwfDF8c2VhcmNofDE1fHxydW5uaW5nfGVufDB8fHx8MTc4NjY5MjgyMHww&ixlib=rb-4.1.0&q=80&w=2000) Photo by [Isaac Wendland](https://unsplash.com/@isaacwendland?ref=thephysiohub.uk) / [Unsplash](https://unsplash.com/?utm%5Fsource=ghost&utm%5Fmedium=referral&utm%5Fcampaign=api-credit) ## What are the most common ankle injuries in runners? There are many possible causes of ankle pain, but a few problems occur particularly frequently in runners. ### Ankle sprains An ankle sprain usually happens when the foot suddenly rolls or twists, overstretching the ligaments around the ankle. The ligaments on the outside of the ankle are affected most commonly. You might notice: - pain around the outside of the ankle - swelling - bruising - difficulty walking - pain when turning or changing direction - a feeling that the ankle is unstable Although it can be tempting to completely rest the ankle until it feels normal, modern ankle-sprain rehabilitation generally encourages **early, protected movement and progressive weight-bearing**, rather than prolonged immobilisation for most uncomplicated sprains. Rehabilitation should then include exercises addressing movement, strength, balance and coordination. A brace or taping can also be useful for some people during the earlier stages of recovery and when returning to higher-risk activities. --- ## Achilles tendon pain The Achilles tendon connects your calf muscles to your heel and has to tolerate substantial loads during running. Achilles tendinopathy usually develops more gradually than an ankle sprain. Typical symptoms include: - pain or stiffness around the Achilles tendon - stiffness when first getting out of bed - pain at the beginning of a run - symptoms which sometimes improve as you warm up but return afterwards - tenderness or thickening around the tendon One of the most important things we have learned about Achilles tendinopathy is that **complete rest is rarely the best long-term treatment**. Progressive tendon-loading exercise is recommended as a first-line treatment. This usually involves progressively strengthening the calf and Achilles tendon using exercises such as calf raises and eventually heavier or more demanding exercises as the tendon becomes stronger. Current clinical guidelines recommend tendon-loading exercise at least three times per week, with the load progressed according to tolerance. Running may sometimes need to be reduced or modified temporarily, but this does not necessarily mean stopping all activity. --- ## Tendon pain around the inside or outside of the ankle The Achilles isn't the only tendon working hard while you run. Several other tendons help control your foot and ankle. The **peroneal tendons**, for example, run around the outside of the ankle, while the **tibialis posterior tendon** passes around the inside. These can become painful following changes in training, particularly when introducing things such as: - longer runs - hills - trails - faster running - significantly more running than usual Treatment will depend on which tendon is involved, but the general principle is similar to Achilles rehabilitation: identify aggravating loads, temporarily modify them if necessary and then **progressively build the capacity of the tendon and surrounding muscles**. Simply resting until the pain disappears and then returning immediately to your previous running volume can leave you in exactly the same situation again. --- ## Bone stress injuries Not all gradual ankle or foot pain comes from tendons. Repeated running loads can occasionally cause a **bone stress injury**, ranging from an early stress reaction through to a stress fracture. ![brown and white skeleton foot](https://cdn.synaps.media/physiohub/content/images/2026/08/photo-1508387104394-d13e1b497f85-1.jpeg) Photo by [Nino Liverani](https://unsplash.com/@ninoliverani?ref=thephysiohub.uk) / [Unsplash](https://unsplash.com/?utm%5Fsource=ghost&utm%5Fmedium=referral&utm%5Fcampaign=api-credit) This is particularly important to recognise because bone stress injuries should not simply be "run through". Warning signs include: - very localised pain over a bone - pain which becomes increasingly predictable during running - pain when pressing directly over one particular area - swelling - pain that begins occurring during normal walking - pain at rest or at night as the problem becomes more advanced Stress fractures do not always show up immediately on a standard X-ray, so persistent focal bone pain sometimes needs further investigation. Rapid changes in training load are one recognised factor in bone stress injuries. Nutrition and overall energy availability matter too: inadequate fuelling relative to training demands is associated with a greater risk of bone stress injury in both male and female athletes. 💡 If a bone stress injury is suspected, it is sensible to get it properly assessed rather than continuing to test it by running. --- # Should you stop running when your ankle hurts? Not necessarily. There is an important difference between **modifying running** and completely stopping activity. For some tendon-related problems, a reduced amount of running can form part of rehabilitation. For other injuries — particularly suspected bone stress injuries or significant acute injuries — continuing to run may be inappropriate. A useful principle is to look at how your ankle responds rather than simply asking whether there is any pain at all. For example, consider: - Is the pain getting progressively worse as you run? - Are you starting to limp or change how you move? - Is your ankle noticeably worse later that day? - Is it significantly worse the following morning? - Are you gradually able to tolerate more, or gradually tolerating less? If your symptoms consistently escalate after running, your current training load is probably more than the ankle can presently tolerate. The solution is often to **reduce the load temporarily and then build it back up**, rather than swinging between running normally and doing nothing. --- # What does good ankle rehabilitation look like? There isn't one exercise programme that suits every ankle injury. A runner recovering from an Achilles problem needs something different from somebody recovering from an ankle sprain. However, rehabilitation commonly progresses through several areas. ### 1\. Restore normal movement Following an injury, the ankle can become stiff. Gradually restoring ankle movement can make walking, running and exercises more comfortable. ### 2\. Rebuild calf strength Your calf muscles play a major role in running. Exercises might progress from: **Double-leg calf raise → single-leg calf raise → weighted calf raise → faster and more explosive exercises** Both straight-knee and bent-knee calf exercises can be useful because they emphasise slightly different parts of the calf complex. ### 3\. Improve balance and control This is particularly important following an ankle sprain. Rehabilitation guidelines recommend balance, coordination and neuromuscular exercises after lateral ankle sprains, particularly because some people otherwise develop recurrent sprains or ongoing feelings of instability. Exercises might progress from simply balancing on one leg to reaching, hopping and eventually running or changing direction. ### 4\. Reintroduce impact Being strong enough to perform a calf raise does not automatically mean the ankle is ready for several thousand running steps. Rehabilitation therefore often progresses through: **Strength exercises → small jumps or hops → repeated hopping → run/walk intervals → continuous running** The exact progression depends on the injury. ![Man jumping rope in a gym.](https://images.unsplash.com/photo-1758875568447-aa45a5d3b351?crop=entropy&cs=tinysrgb&fit=max&fm=jpg&ixid=M3wxMTc3M3wwfDF8c2VhcmNofDZ8fGFua2xlJTIwZXhlcmNpc2V8ZW58MHx8fHwxNzg2NjkzMzkyfDA&ixlib=rb-4.1.0&q=80&w=2000) Photo by [Vitaly Gariev](https://unsplash.com/@silverkblack?ref=thephysiohub.uk) / [Unsplash](https://unsplash.com/?utm%5Fsource=ghost&utm%5Fmedium=referral&utm%5Fcampaign=api-credit) --- # When can I start running again? There isn't a universal test that tells every runner when they're ready. Before returning after a more significant ankle injury, it is usually helpful to be able to: - walk briskly without a significant limp - climb stairs comfortably - perform repeated calf raises - balance confidently on the affected leg - tolerate some hopping or impact where appropriate - complete your rehabilitation exercises without a major flare-up afterwards Your first run back also doesn't need to be your previous 5K or 10K. Starting with a combination such as: **2 minutes running / 1 minute walking** can allow you to see how the ankle responds before gradually increasing the amount of continuous running. --- # Can ankle injuries in runners be prevented? Unfortunately, no programme can guarantee that you will never get injured. Running injuries are influenced by many factors including previous injury, training, recovery, tissue capacity and sometimes simple bad luck. There are, however, a few sensible things we can do. ## Avoid sudden changes in your running One of the biggest mistakes runners make is changing several things at once. For example: > New shoes + longer runs + speed sessions + three extra runs each week. Your cardiovascular fitness may cope surprisingly well with the increase, while your tendons, muscles and bones need longer to adapt. Interestingly, the traditional **"increase your weekly mileage by no more than 10%"** rule is not particularly well supported by evidence. A large 2025 study found that injury risk was more clearly associated with suddenly making an individual run substantially longer than the longest run completed during the previous month. Simple week-to-week mileage percentage changes were much less useful for predicting injury. So rather than obsessing over a precise percentage, a better principle is: **Avoid sudden spikes in what you ask your body to do.** --- ## Strengthen your ankles and calves Strength training has many benefits for runners, although it is important not to oversell it as a guaranteed injury-prevention tool. A 2024 systematic review found that exercise-based programmes overall had not consistently reduced running-related injuries, although supervised programmes may perform better. There is stronger evidence in specific situations. For example, following an ankle sprain, balance and neuromuscular rehabilitation can help address ongoing instability and reduce the likelihood of recurrent problems. From a practical point of view, keeping the calf and ankle strong also helps prepare these tissues for the demands you are asking of them. --- ## Don't become obsessed with the "perfect" running shoe Running shoes can change how loads are distributed through your legs, but there is surprisingly little evidence that one particular category of shoe prevents running injuries for everybody. A Cochrane review concluded that most evidence does not show a clear reduction in lower-limb injury simply from prescribing one particular type of running shoe over another. That means you don't necessarily need: - a particular amount of cushioning - a particular heel-to-toe drop - a "stability" shoe because somebody said you pronate - the most expensive shoe available Comfort, fit and suitability for the type of running you do are reasonable priorities. And if you are making a major change — particularly towards very different or minimalist footwear — introduce it gradually rather than changing everything overnight. --- ## Give your body enough fuel and recovery Running creates a training stimulus. Recovery is when your body adapts to it. That means your training plan needs to leave room for sleep, recovery and adequate nutrition. This becomes particularly important when running volumes increase. Persistent under-fuelling relative to exercise demands can affect multiple body systems and is associated with poorer bone health and an increased risk of bone stress injuries. More training is not automatically better training. --- # When should you get an ankle injury checked? Most minor aches and uncomplicated sprains settle with appropriate management. There are times, however, when assessment is sensible. Seek medical advice following an acute injury if: - you cannot put weight through the leg or walk more than a few steps - there is substantial or worsening swelling or bruising - the ankle looks deformed - pain is severe or worsening - you develop numbness or significant altered sensation ![person sitting while using laptop computer and green stethoscope near](https://cdn.synaps.media/physiohub/content/images/2026/08/photo-1576091160550-2173dba999ef.jpeg) Photo by [National Cancer Institute](https://unsplash.com/@nci?ref=thephysiohub.uk) / [Unsplash](https://unsplash.com/?utm%5Fsource=ghost&utm%5Fmedium=referral&utm%5Fcampaign=api-credit) NHS guidance recommends seeking urgent advice for significant pain, worsening swelling/bruising or an inability to weight-bear following an injury. You should also seek assessment if you suddenly feel or hear a **pop at the back of the ankle**, particularly if it feels as though somebody kicked you in the calf and you struggle to push off or stand on your toes. These can be features of an Achilles tendon rupture. Gradually developing pain should also be assessed if it is becoming more severe, consistently limiting your running, or particularly if you have **very localised tenderness directly over a bone**. --- # The bottom line Ankle pain doesn't automatically mean you need to stop running for months. But repeatedly ignoring it isn't a particularly good strategy either. For many running-related ankle problems, successful rehabilitation involves: **identifying the problem → adjusting the aggravating load → rebuilding strength and capacity → gradually returning to running.** The aim isn't simply to make the pain disappear. It's to make the ankle capable of tolerating the running you want to do. If ankle pain keeps returning, you're unsure what is causing it, or you don't know how to safely progress back to running, an individual assessment can help identify what is limiting you and build a rehabilitation programme around your symptoms and goals. --- ## Need help with an ankle injury? If ankle pain is stopping you from running or keeps returning every time you increase your training, I can help you work out what may be causing it and what you can do next. **Book a FREE 15-minute consultation** to talk through what's been happening, what you've already tried and whether physiotherapy or a personalised rehabilitation programme may be appropriate. There's no obligation to continue afterwards. [Book a Physiotherapy Consultation ](https://cal.eu/thephysiohub/free-consultation?ref=thephysiohub.uk) --- #### Evidence used in this article This article draws particularly on: - Martin RL et al. **Lateral Ankle Ligament Sprains: Clinical Practice Guidelines*. Journal of Orthopaedic & Sports Physical Therapy, 2021. - Chimenti RL et al. **Midportion Achilles Tendinopathy: Clinical Practice Guideline Revision*. Journal of Orthopaedic & Sports Physical Therapy, 2024. - Frandsen J et al. Research examining running-distance progression and injury risk, British Journal of Sports Medicine, 2025. - Hoenig T et al. **International Delphi consensus on bone stress injuries in athletes*, British Journal of Sports Medicine, 2025. - Relph N et al. **Running shoes for preventing lower limb running injuries in adults*, Cochrane Database of Systematic Reviews, 2022. - Wu H et al. Systematic review of exercise-based running-injury prevention programmes, **Sports Medicine*, 2024.