Medial ankle pain refers to pain on the inside of the ankle. Pain on the inside of the ankle is either gradual onset overuse (chronic), or sudden onset (acute) sprains, strains and fractures. Here we explain the symptoms and causes of inside ankle pain.
Acute ankle sprains, strains & fractures
- An eversion ankle sprain will cause injury to the ligaments on the inside of the ankle.
- An inversion ankle sprain will likely cause most pain on the outside of the ankle. However, bruising of the bone on the inside of the ankle can also occur from compression.
- Ankle fractures are also common sporting injuries.
Read more on acute ankle injuries.
The two most common causes of gradual onset medial ankle pain are Tibialis posterior tendinopathy and Flexor hallucis longus tendinopathy.
Tibialis posterior tendinopathy/tendonitis
Tibialis posterior tendinopathy is degeneration of the tibialis posterior tendon on the inside of the ankle. The tibialis posterior tendon runs just behind and below the medial malleolus (bony bit) on inside of the ankle.
- Pain may also radiate under the foot arch, along the path of the tendon.
- It is more likely to affect older female athletes who do a lot of walking or running.
- However, athletes who do sports and activities such as ballet dancing, ice skating, or track sprinting around bends are at a higher risk.
- Tendonitis referrs to actual ‘inflammation’. Tendinopathy includes wear and tear or degeneration which most long term injuries are likely to be.
Read more on Tibialis posterior tendinopathy
Flexor hallucis longus tendinopathy
Flexor hallucis longus tendinopathy or flexor tendonitis is inflammation or degeneration of the flexor tendons in the foot. Symptoms include:
- Pain on the inside of the ankle.
- Specifically, pain along the length of the tendon as it passes around the back of the medial malleolus and into to the arch of the foot.
Read more on Flexor hallucis longus tendonitis.
Medial calaneal nerve entrapment
Medial calcaneal nerve entrapment has similar symptoms to that of tarsal tunnel syndrome.
- The medial calcaneal nerve becomes impinged or pinched on the inside of the ankle.
- Pain radiates from the inside of the ankle & heel, out towards the centre of the heel.
Read more on medial calcaneal nerve entrapment.
Tarsal Tunnel Syndrome
Tarsal tunnel syndrome is caused by pressure on the posterior tibial nerve as it passes on the inside of the ankle.
- It can cause burning pain in the heel that can radiate into the arch of the foot.
- The sole of the foot may feel numb or have pins and needles.
- Treatment involves rest and identifying the underlying cause of the condition.
- Most are treated with cold therapy, physical therapy, and biomechanical assessment, however, injections and surgery are required in some cases.
Read more on Tarsal Tunnel Syndrome
Talar stress fracture
The talus bone is the bone at the top of the ankle which the tibia or shin bone sits on. A stress fracture of the talus is a hairline crack in the bone caused by overuse.
- Symptoms are more likely to include gradual onset pain on the outside of the ankle, but may also be felt on the inside.
- Exercise will make symptoms worse, particularly running, and symptoms will ease with rest.
Read more on Talar stress fracture.
Medial malleolar stress fracture
The medial malleolus is the bony bit on the inside of the ankle. A stress fracture of the medial malleolus can occur but is very rare2.
- It causes pain on the inside of the ankle which is exacerbated by activity, especially running and jumping activities.
- You will have specific point tenderness over the medial malleolus where the fracture is located.
- You may also be swelling, but not in all cases.
- If the stress fracture is in the early stages it may not show up on X-ray but a bone scan, CT scan, or MRI can confirm the diagnosis.
Read more on Medial malleolar stress fracture.
Posterior ankle impingement
Ankle impingement is when a bony growth at either the front or back of the ankle bone restricts normal ankle range of motion. Impingement means tissues have become trapped between bones.
- Pain is usually felt at the back of the ankle but can radiate or manifest on the inside of the ankle.
- There will be tenderness behind the bottom tip of the fibula bone.
- Pain will most likely be worse at the end of the movement when the foot is pointed down into plantarflexion with the foot pointing downwards.
- Going up onto tiptoes may be painful. An X-ray can show up any bony spurs on the talus (heel bone) and end of the tibia (shin bone).
Read more on Ankle impingement.
Tibialis posterior tendon dislocation
Dislocation of the tibialis posterior tendon is rare in sport. It occurs when the tibialis muscle pulls the tendon out of its retinaculum. The retinaculum is the tissue which holds it in place on the inside of the ankle. Symptoms include:
- Moderate pain on the inside of the ankle.
- You may be unable to weight bear on the injured ankle.
Treatment involves immediate surgery to repair the retinaculum1. The ankle is then immobilised in a walking boot (non weight bearing) for 6 weeks. Then an ankle brace is used to provide protection and support. Ankle mobility exercises can begin.
However, it is important to avoid resisted inversion (turning your foot inwards against resistance as this could over-stress the inside of the ankle.
Pain on the inside of the ankle may be referred from injuries or conditions elsewhere in the body. For example, sciatic pain from the lower back can radiate down into the leg. Trapped nerves in the foot may also cause medial ankle pain.
Medial ankle pain – important do not miss:
The following injuries do not commonly cause pain on the inside of the ankle, however, if missed, more serious long term damage may occur.
Navicular stress fracture
- Symptoms of a navicular stress fracture include a poorly localized ache in the midfoot which gets worse with exercise.
- Pain may radiate along the inside arch of the foot and goes away quickly with rest, only to return again as training resumes.
- Tenderness may be felt when the thumb is pressed into the top of the foot over the navicular bone, called the N spot.
Read more on Navicular stress fracture.
Ankle sprain complications
- Complications of ankle sprains and Complex regional pain syndrome should also not be overlooked.
References & further reading
- Rolf C, Guntner P, Ekenman I et al. Dislocation of the tibialis posterior tendon: diagnosis and treatment. J Foot Ankle Surg 1997;36(1):63–5.
- Brukner P, Bennell K, Matheson G. Stress Fractures. Melbourne: Blackwells Scientific Asia, 1999.