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Inside ankle pain can happen for many reasons. It could be an injury, overuse, or gradual wear and tear on the inner, or medial, ankle joint, for example.
This ankle pain can become very frustrating if it doesn’t go away!
You might notice you can’t walk as well. Maybe it’s painful to put weight on that leg. It could even be tough to wear shoes because of the pressure against the inner ankle.
Because of how bothersome this inner ankle pain can be, we have to get to the bottom of why it’s happening!
Table of Contents
Anatomy of the Inner Ankle
Let’s start with the basics to better understand inner ankle anatomy.
Knowing and understanding this information will better help to understand the possible causes of inner ankle pain and how to treat it.
Bony Structures of the Inner Ankle
The ankle joint is made from three bony structures:
- Tibia, or shin bone
The ankle joint is formally called the talocruraljoint.
This is a synovial, hinge joint responsible for the motions of dorsiflexion, plantarflexion, inversion and eversion.
The bony structure we know as the medial malleolus is your inner, or medial, ankle bone. It’s a bony projection at the bottom of the tibia.
Ligaments of the Inner Ankle
Various ligaments connect bone to bone surfaces on the inside of the ankle. These ligaments help to provide support and stability to the medial ankle.
The deltoid ligament is technically comprised of four separate ligaments:
- Tibiocalcaneal ligament (superficial)
- Tibionavicular ligament (superficial)
- Posterior tibiotalar ligament (deep)
- Anterior tibiotalar ligament (deep)
The deltoid ligament attaches from the medial malleolus to the calcaneus, navicular and talus bones of the foot and ankle. It’s largely responsible for making sure the ankle doesn’t overly evert or roll inward.
The springligament, also known as the plantar calcaneonavicular ligament, connects the calcaneus, or heel bone, with the navicular bone in the foot. It’s surrounded by the deltoid ligament, posterior tibial tendon, and bifurcate ligament.
The spring ligament helps support the inner or medial longitudinal arch of the foot. This makes sure your inner arch doesn’t collapse and supports you while standing and walking.
The bifurcateligament connects the anterior part of the heel bone with the navicular and cuboid bones of the foot. While this ligament is commonly sprained from an inversion ankle injury, because of its connection to the navicular bone, inner ankle pain can result.
The medial talocalcaneal ligament connects a bony structure on the talus, called the medial tubercle, with another structure called the sustentaculum tali, which is a specific area on the heel bone. This ligament tends to blend in with the spring ligament.
Tendons of the Inner Ankle
The tendons that run along the inside of the ankle into the inside of the foot include the following:
- Posterior tibial tendon – Action of muscle: plantarflexion and inversion of ankle
- Flexor digitorum longus tendon – Action of muscle: flexion or bending of toes 2-4
- Flexor hallucis longus tendon – Action of muscle: flexion or bending of big toe and ankle plantarflexion
- Anteriortibial tendon – Action of muscle: dorsiflexion and inversion of ankle
The tarsal tunnel is a tunnel on the inside of the ankle formed by the inner ankle bones and ligaments. Multiple structures pass through the tarsal tunnel, including the following:
- Tibial nerve (a.k.a. posterior tibial nerve in the area of the inner ankle)
- Posterior tibial artery
- Posterior tibial vein
- Tendons of posterior tibialis, flexor digitorum longus, and flexor hallucis longus
Inner Ankle Pain Causes & Symptoms
Now that you’re an expert on inner ankle anatomy, we can dive into the possible causes and symptoms of inner ankle pain.
Here we go!
Inner Ankle Tendonitis
Tendonitis is an overuse injury. It can happen to any of the muscle-tendon units that run to and through the inner ankle.
Overuse can happen as a one-time incident, or it could be repetitive overuse over a longer period of time. It may be related to sports or other repetitive actions at the ankle, such as with walking, running, or jumping.
Posterior tibial tendonitis is one of the most common types of inner ankle tendonitis pain.
Symptoms: While some symptoms may vary slightly, depending on the exact muscle and tendon involved in the tendonitis, the following are common symptoms of an overuse injury around the inner ankle.
- Tenderness occurs when you touch the painful area
- Swelling and inflammation at the inside of the ankle
- Possible warmth
- Decreased or stiff ankle range of motion
- Ankle weakness
- Difficulty walking
Inner Ankle Tendon Rupture
An inner ankle tendon rupture is much more severe than ankle tendonitis.
A tendon rupture commonly occurs from a more sudden, traumatic injury to the inner ankle. This is more common with high impact sports that involve running and jumping.
Symptoms: Below are some of the most common symptoms associated with an inner ankle tendon rupture.
- Popping sound at the time of injury
- Sudden pain and swelling of the inner ankle
- Possible bruising on the inner ankle
- Decreased range of motion
- Weakness and/or instability of the ankle
- Difficulty or inability to weight bear on the injured leg
Inner Ankle Sprain
An ankle sprain is an overstretching or tearing of a ligament, depending on the grade of the sprain. An inner ankle sprain is specific to any of the inner ankle ligaments.
Inner ankle sprains can be separated into 3 grades, ranging from mild, moderate to a severe sprain.
The most common way of causing a medial, or inner, ankle sprain is by overly everting the ankle, or when the ankle rolls inward.
Symptoms: The exact symptoms and severity of symptoms will vary depending on the grade of the sprain, but the following are common symptoms associated with a sprained inner ankle.
- Immediate pain upon injury
- Swelling and possible bruising of the medial ankle
- Decreased ankle range of motion
- Ankle weakness
- Tenderness occurs on the inside of the ankle
- Mild to moderate sprains will likely allow you to still weight bear, but with difficulty. Moderate to severe sprains may keep you from being able to weight bear at all.
A muscle strain can occur anywhere along the muscles and their tendon connections that run along the inside of the ankle. The strain may occur in the muscle belly (e.g., posterior tibial muscle or other calf muscle), which would be in the lower leg or it could be where the tendons run directly along the inside of the ankle.
Even if the strain occurs in the muscle belly, it can translate pain to its tendon connections that run along the inside of the ankle.
Symptoms: Specific testing will need to be done to determine which exact muscle-tendon unit is strained, but most strains will cause the following symptoms.
- Pain and tenderness at the location of the strain
- Muscle spasms or trigger points
- Medial ankle swelling
- Decreased ankle range of motion
- Ankle weakness
- Pain with walking
- Difficulty weight bearing on the injured leg
Inner Ankle Fracture
Inner ankle fractures can involve any of the medial ankle bones.
A fracture, or broken ankle, is usually a traumatic injury, usually with immediate pain onset. With a fracture, you likely won’t be able to take more than a few steps on the injured leg, if any at all due to pain.
A traumatic fracture usually requires immediate medical attention.
There is the possibility of a stress fracture, which can initially begin as more of a dull ache in the injured area. A stress fracture can occur from repetitive overuse, especially with higher impact sports and activities like running, and gradually stress the bone to the point of a fracture.
Symptoms: An inside ankle fracture will typically include the following symptoms.
- Medial ankle pain (immediate pain is common with traumatic fractures, whereas a gradual build-up of pain can occur with a stress fracture)
- Pain and tenderness
- Inability to weight bear on the affected foot
- Decreased or inability to perform ankle range of motion
- Ankle weakness and instability
Inner Ankle Arthritis
Various types of arthritis can occur in the medial ankle joint.
Osteoarthritis is the most common type of arthritis the joints will experience. This is a degenerative arthritis that occurs from natural wear and tear in the body.
Other types of arthritis have more of an inflammatory component, such as gout or rheumatoid arthritis.
Symptoms: Most types of inner ankle arthritis will have similar symptoms, such as the following.
- Ankle stiffness, usually worse after inactivity
- Medial ankle pain
- Medial ankle swelling
- Decreased ankle range of motion
- Decreased ankle strength and stability
- Pain will ease with resting
Tarsal Tunnel Syndrome
Tarsal tunnel syndrome occurs when the posterior tibial nerve becomes compressed.
This nerve compression can happen for a variety of reasons, such as having naturally flat feet, inside ankle swelling, bone spurs, etc.
Symptoms: Tarsal tunnel syndrome is usually accompanied by one or more of the following symptoms.
- Numbness and/or tingling in the bottom of the affected foot
- Medial ankle pain worse in standing
- Swelling on the inside of the ankle
- Electric or burning sensation in the inner ankle and/or foot
- Weakness on the inside of the foot and ankle
Confirming an Inner Ankle Pain Diagnosis
How do you test for inside ankle pain?
Many times, your injury description and a good physical exam from the right healthcare provider will confirm your inner ankle pain diagnosis.
If your inside ankle pain is related to a known trauma or your pain has been going on for a while without improvement, then imaging may be ordered.
X-rays are helpful for ruling out a fracture. CT scans and an MRI are better forms of imaging for assessing soft tissue damage, such as with muscles, tendons and ligaments.
Inner Ankle Pain Treatment
The specific treatment you’ll need for you inside ankle pain will depend on the exact injury.
More mild injuries, such as a mild sprain, strain or tendonitis, can respond well to home treatment.
This home treatment will usually include R.I.C.E: Resting, icing, compression and elevation.
You’ll want to modify your activity level, especially avoiding too much standing and walking for a few days.
An ankle brace or wrap can be helpful for reducing pain and inflammation.
Once your inner ankle has had a chance to heal, specific ankle exercises can be beneficial (more on that below!).
If you’ve tried home treatment for your ankle pain for 1-2 weeks (not related to a specific trauma), and your inside ankle pain is still persisting, then make sure to consult with your doctor.
Medial ankle injuries commonly require physical therapy for the best recovery.
Different tools and equipment may be used to help with pain and swelling management. Exercise and manual therapy are used to help address range of motion and weakness.
All of these measures will help get your ankle back into tip top shape.
When inner ankle pain and instability are the problem, your physical therapist may try out some taping of the medial ankle. This will help to better support and protect the ankle while you’re initially recovering.
While there are a few ways to tape the medial ankle, check out the video below for a demonstration of one effective method.
The exercises recommended by your physical therapist will vary, depending on your exact injury. We’ll go over some basic exercises though that focus on improving strength and mobility of the inner ankle structures.
1. Ankle Plantarflexion with a Resistance Band
You can do this seated in a chair with the working leg stretched in front of you. You can also do this one on your floor or bed with the legs stretched out in front of you. Either is fine!
- Loop a resistance band (light, medium or heavy resistance) around the ball of foot on the injured side. Hold the ends of the band in the hands.
- Have the ankle in a starting position of ankle dorsiflexion. Slowly allow the foot to press forward to move into ankle plantar flexion.
- Only move within a tolerable range of motion.
- Hold this position for 2 seconds, then slowly return to your starting position.
- Repeat 10-15x for 2-3 sets.
2. Ankle Inversion with a Resistance Band
This is another you can do seated in a chair or positioned on the floor or bed with your legs stretched in front of you like the above exercise.
- Loop your same resistance band (light, medium or heavy resistance) around the ball of foot of the working leg.
- Hold the ends of the band in the hands, but this time angle the band away from the inside of the ankle.
- Slowly point the foot forward, then scoop inward towards the other leg. Hold for 2 seconds, then return to your starting position.
- Repeat 10-15x for 2-3 sets. Only move within a tolerable range of motion.
3. Double Leg Calf Raise
- Stand with both feet flat on the floor in front of a sturdy surface, like a countertop.
- Slowly lift the heels off the floor so that you lift yourself onto the toes. Move as high as your ankle feels comfortable with.
- Slowly return to your starting position.
- Repeat 10-15x for 2-3 sets.
Tip: If you’ve advanced to the point that a double leg calf raise becomes too easy, you can up the challenge by making it a single leg calf raise.
The video below will show you how to do a single leg calf raise the right way.
4. Self-Ankle Range of Motion
Often after a medial ankle injury, your range of motion may be tight and limited. Which direction is tight can depend on the exact injury.
We’ll take a look at how to practice self-range of motion on the ankle in each of its four primary directions.
For each of these you’ll be seated in a chair with the injured leg crossed over the opposite side.I
f the ankle is very stiff and a little sensitive, you may do better with a shorter hold time for your stretch, like 5 seconds, and repeating several times, such as up to 10x.
If you can tolerate a longer hold time, like 20-30 seconds, then you only need to repeat 2-3x.
Gently pull the foot and ankle directly back until you feel a light stretch in the back of the ankle.
Gently push the foot and ankle directly forward until you feel a light stretch over the top of the ankle and foot.
Gently push the foot forward like you did with ankle plantarflexion, but then pull the foot and ankle inward (the bottom of the foot will point more towards the ceiling).
Gently pull the foot and ankle back like in ankle dorsiflexion, but then push the foot and ankle outward (the bottom of the foot will point more towards the floor.
Just in case you’re needing a little more of a visual, take a look at the video below demonstrating all of the above directions to practice self-ankle range of motion.
More serious inside ankle injuries may require surgical treatment.
This is more common with severe injuries such as a tendon rupture or fractured ankle.
If you do need surgery, your recovery time is usually longer than if you didn’t need surgery. It could take a few months to a year for full recovery.
When you’re able to start physical therapy will also depend on the surgery and possible time needed to immobilize the ankle before rehab.
The foot and ankle may require use of a walking boot, brace or other type of splint before you can begin using the ankle again.
You may even be given weight bearing restrictions by your surgeon at first, meaning you’ll only be allowed to put a certain amount of weight, if any at all, on the injured leg.
It’s important to follow the instructions of your surgeon and physical therapist after your surgery for the best recovery.
Taking it All In
There’s a lot of things that can happen to the inside of the ankle!
Hopefully this gives you a better idea of what might be causing your inner ankle pain.
Remember, if you’re having ongoing inner ankle pain or have had an injury causing your pain, make sure to see your doctor! The sooner you get things checked out, the sooner your recovery can begin.
How long will it take for a minor inner ankle injury to recover?
Minor injuries may take a few weeks or up to a month to recover as long as you address your pain right away. Don’t ignore it!
Should I use ice or heat on my ankle?
Ice is usually the better choice, especially for recent ankle injuries and pain. It helps with swelling and inflammation.
Can I walk with inside ankle pain?
If you haven’t been instructed by your doctor to limit your walking and weight bearing, then you can try light walking. Keep your distances short and don’t continue if your pain is getting worse.