Inner Ankle Pain Causes & Treatment
Inside (medial) ankle pain can keep you from running, playing sports, or just living life the way you want to. It often occurs after running and may appear suddenly without injury and have no swelling. Conversely, it can also just as often appear with swelling and as a result of an acute injury such as a twisted ankle or fall.
Below are some of the most common causes, symptoms, and treatment options for inner ankle pain that I see as a physical therapist.
Inner Ankle Pain Common Causes
- Deltoid Ligament Ankle Sprain
- Posterior Tibial Tendonitis
- Medial Malleolus Fracture
- Tarsal Tunnel Syndrome
- Ankle arthritis
OpenStax College, CC BY 3.0, via Wikimedia Commons
Deltoid Ligament Ankle Sprain Diagnosis
The deltoid ligament is a strong, triangular ligament located on the medial (inner) side of the ankle, providing stability by connecting the tibia to several bones in the foot. A sprain occurs when this ligament is stretched or torn.
Symptoms
- Swelling and tenderness around the inner ankle
- Possible bruising
- Pain when putting weight on the affected foot, or when everting the ankle
Common causes
- An outward twisting of the ankle (eversion)
- Direct impact or trauma to the inner ankle
- Activities like soccer, football, hiking
Y. Yang et al. , CC BY 4.0, via Wikimedia Commons
Posterior Tibial Tendonitis Diagnosis
Other names include posterior tibial tendinopathy and posterior tibial tendon dysfunction. This injury involves irritation of the posterior tibial tendon, which is responsible for supporting the arch of the foot and supination. For most people, this tends to be an overuse injury: the tendon can no longer support the demands of the current activity level.
Symptoms
- Pain and possible swelling along the inner ankle and arch of the foot
- Decreased ability to perform a single leg heel raise
- Collapsed foot arch, abnormal wear on inside of shoes
Common Causes
- Large increase in activity levels in a short period of time such as running
- Recent trauma to the area
- Risk factors include: flat feet, obesity, diabetes, hypertension
James Heilman, MD, CC BY-SA 4.0, via Wikimedia Commons
Medial Malleolus Fracture Diagnosis
The medial malleolus is the bony prominence on the inner side of the ankle. A fracture occurs when there is significant trauma to the area.
Symptoms
- Immediate, sharp pain at the site of the fracture
- Swelling and bruising around the inner ankle
- Difficulty walking or bearing any weight on the affected side
Common Causes
- Rolling an ankle either outward or inward
- Twisting an ankle while the foot is planted
- Direct blow to the inner ankle
Nicole Williams et al., CC BY 4.0, via Wikimedia Commons
Tarsal Tunnel Syndrome Diagnosis
This condition occurs when the posterior tibial nerve, which runs through a narrow passageway behind the inside ankle bone, becomes compressed. Tarsal tunnel syndrome tends to be rare, so other diagnoses should be ruled out first.
Symptoms
- Tingling, burning, or a sensation of ‘pins and needles’ along the inner ankle and foot
- Pain at night time
- Potential loss in muscle strength of the ankle and foot
Common Causes
- Structural abnormalities or conditions that reduce space in the tarsal tunnel
- Ankle swelling that compresses the tibial nerve
- No known cause is estimated in >20% of cases
Attribution:
Hio N, Hasegawa et al., CC BY 4.0, via Wikimedia Commons
Ankle Arthritis Diagnosis
Ankle arthritis involves the degeneration of the joint cartilage in the ankle. It can result from wear and tear (osteoarthritis) or injury (post-traumatic arthritis).
Symptoms
- Morning stiffness
- Decreased range of motion
- Gradual onset over time
Common Causes
- Previous history of fracture or ankle surgery (70% of cases are post-traumatic)
- Wear and tear over time (less common)
Inner Ankle Pain Treatment
The outdated model for treating medial ankle pain usually goes something like this:
rest → PCP visit → medication → PCP visit → physical therapy
The issue is, some of these diagnoses won’t get better with rest. This means a month has gone by with multiple copays and unnecessary medication.
I have my bias as a PT, but this is the model that I think works best for most people:
- Obvious signs of fracture or major trauma → urgent care / PCP visit
- No major trauma → physical therapy → activity modification & exercise → referral out if needed
Below are some common treatment options for the diagnoses discussed.
Deltoid Ligament Ankle Sprain Treatment
This type of ankle sprain will usually heal on its own and responds well to physical therapy. A typical course of treatment may involve:
- Ankle brace use
- Range of motion exercises → strengthening → plyometrics → return to impact activities
- Additional prescription of balance and proprioception exercises
Posterior Tibial Tendonitis Treatment
Current research indicates that load management is the most important component of injury rehab for posterior tibial tendinopathies. Additionally, adding foot orthotics may be beneficial when coupled with physical therapy with a focus on:
- Ankle mobility & strengthening exercise
- Hip strengthening
- Single leg balance and proprioception exercises
Medial Malleolus Fracture Treatment
If you suspect that you may have a fracture, it’s important to see a healthcare provider immediately. Typically they will run you though something called the Ottawa ankle rules, a series of tests to see if you need an X-ray.
If you have a fracture, treatment may consist of:
- Casting or placing the ankle in a boot, and avoiding weightbearing with crutches
- Surgery such as open reduction and internal fixation (ORIF)
- Eventual physical therapy to address muscle atrophy and joint stiffness
Tarsal Tunnel Syndrome Treatment
Treatment largely depends on the root cause, often determined by imaging. Conversative care typically consists of anti-inflammatories, physical therapy, and activity modifications. If structural abnormalities are present then surgery may be warranted.
Common treatment options:
- Physical therapy to target deficits in strength/mobility
- NSAIDS or corticosteroids
- Decompression surgery
Ankle Arthritis Treatment
Although ankles are one of the less common joints to experience arthritis, they respond well to conservative care. Surgery such as ankle joint replacement is rare. Typical treatment includes:
- Physical therapy to address joint stiffness and strength deficits
- NSAIDs & corticosteroids
- Education and self-care management strategies
Understanding the nuances of inner ankle pain through common causes, symptoms, and treatment options should give you a good starting point for your injury rehab. If you’re still feeling unsure, contact your local physical therapist or other healthcare provider for more information.
