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Ankle injuries in runners

Ankle injuries that affect runners can be broadly divided in to sprains (stretching of the strong ligaments around the ankle) or repetitive strain injuries. Ankle sprains have a range of severity and typically affect the lateral structures when the ankle is twisted or rolls over. The repetitive strain injuries usually affect the posterior tibialis tendon (inside ankle) and the Achilles tendon (back of ankle).


Sprain or tendon inflammation?


A sprain happens when you roll your ankle on landing the foot, whether this is a mis-step or due to uneven ground and is associated with a sharp pain. Runners are often able to carry on, or hobble on, but then comes the swelling and bruising which makes further weightbearing very painful. Correct initial treatment can prevent recurrence and chronic instability.


Tendon inflammation, or repetitive strain, causes pain on weight-bearing without the same amount of swelling seen with sprains. Pain along the path of the tendon is usually slowly progressive and eases with rest. This inflammation can lead to scar tissue forming and this makes the tendon less flexible and is therefore forced to work harder. The tendons are at risk of rupture, partial or complete, if stressed further whilst inflamed.


How to treat?

If you are not sure why you are in pain it is sensible to seek medical advice, as investigations may be needed to rule out a fracture.


For sprain and tendon inflammation, ice therapy should be started as soon as possible. There are different protocols; 10 minutes of icing, followed by 10 minutes of rest and then another 10 minutes of icing is a satisfactory protocol. Elevation of the ankle should also be incorporated, with early rehabilitation which can include calf stretching and range of motion exercises (this can start within a week of the injury). When you can put weight on the ankle without pain balance work (including wobble board) can be started.


Return to running?

This should be possible once you can walk without pain, however you do need to build up slowly and start running on the flat initially. It maybe suggested you do intervals of running and walking until you get back to your normal speed and distance.



After 6 weeks, if symptoms are not improving it may be advisable to perform a magnetic resonance imaging (MRI) scan to assess further.


If the ankle remains unstable (sprains) or Achilles tendinopathy fails to settle, surgical reconstruction (sprains and posterior tibial tendon dysfunction) or debridement (Achilles tendinopathy) can be considered after a thorough discussion of the options.


I am a fellowship trained trauma and orthopaedic surgeon specialising in foot and ankle conditions. My NHS practice is in East Kent, however I do see patients in London as well. I deal with all foot and ankle conditions, including sports injuries and fractures.

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