This article originally appeared in the September issue of Women’s Running

Your ankles undergo a lot of stress when we run, making this area susceptible to pain and injury. While most running injuries tend to be of the soft-tissue variety (from misuse or overuse), ankle injuries run the gamut from tendinosis and stress fractures to acute strains and sprains. And if your ankle pain occurs gradually or comes and goes with activity, it can be tough to diagnose. Read on to learn about some of the most common ankle injuries, why they happen and how to treat them.


Say you’re heading out for a run and feel fine before you start, but as you get moving, your Achilles tendon begins to hurt. It feels uncomfortable but not unbearable, so you keep going. Immediately post-run, you feel fine, but later in the day, you’re in pain again.

“Tendonitis is one of the most common ankle injuries we treat,” says Brett Sachs, D.P.M., a foot and ankle surgeon in Wheat Ridge, Colo., who frequently sees runners. “Usually it will cause pain during a run, and then afterward, once your endorphin level decreases and muscles start to tighten up, you’ll feel a dull ache at the back of your ankle.”

Tendonitis can also affect the peroneal tendons, the fleshy area just behind the bone on the outside of your ankle.

Why It Happens

Tendinosis is inflammation of the tendon, which connects muscle to bone. Sachs says tendonitis often occurs with overuse, improper footwear (either worn-out or wrong for your foot type) and/or poor running mechanics.

How To Treat It

For mild cases, RICE (rest, ice, compress, elevate), with an emphasis on rest, should do the trick. But if symptoms haven’t improved after a few days, see a doctor, says Sachs.

Stress Fracture

A stress fracture, or tiny crack in the bone, will cause pain in a very specific location and often bruising and swelling. “It will hurt when you put pressure on your foot and get worse as you continue moving,” Sachs says.

Sachs compares a stress fracture to a crack in an egg: if you leave it alone, nothing will happen, but if you keep applying force to it, the egg will eventually crack open. A stress fracture may be inconvenient, but it’s sure better to rest than to deal with a full-blown fracture.

Why It Happens

Stress fractures typically occur for one of two reasons: abnormal stress (such as doing too much too soon, or faulty gait mechanics) on normal bone or normal stress on abnormal bone (such as with osteoporosis).

How To Treat It

See a doctor if you have symptoms. You will need to rest and may need to wear a boot for immobilization. It can take four to six weeks for a stress fracture to heal.


So you’re running on a trail and things get a little too technical. You roll your ankle on a root and
immediately know something’s not right. It’s swollen, bruised and hurts to put weight on it. You’ve likely suffered a sprain.

Why It Happens

A sprain occurs when one or more ligaments (which connect bone to bone) stretch or tear from trauma or from the joint being taken beyond its normal range of motion.

How To Treat It

RICE. If it doesn’t improve in a few days, see a doctor for a professional evaluation.

Keep Your Ankles Happy And Healthy

While it’s impossible to completely prevent ankle injuries, you can take these steps to reduce their likelihood, says Sachs.

  • Before a run, warm up with dynamic stretching targeting the lower legs and ankles.
  • Be reasonable with progressions in your training. Avoid rapid increases in mileage, and be careful when changing terrain.
  • Change your shoes frequently (every 3–6 months). If you’re not sure whether you’re wearing the right shoes, visit a specialty running store for an evaluation.
  • Include ankle range-of-motion exercises in your strength-training regimen. Sachs recommends using your foot to “write” the alphabet, which will move your ankle in all different planes and directions.
  • Improve your ankle stability through single-leg balance exercises. If falling and ankle sprains are an issue for you, see a physical therapist to help you get started.