Running Pain Inner Ankle's

[HybridHayley]

Hello

I wondered if anyone had or has a similar issue to me. I have been running since January, from barely running 60 seconds I can now run 29 mins covering 4.5km. Its been a hard but awesome journey to get this far even after a months break.

Anyway, 15-20 mins in I start to get a pain which begins around the inner ankles and up my leg.

This image is exactly were it hurts (red bit). The Tibialis Posterior, I sometimes get that extending down my arch to my big toe but this off and one. Mostly its just around my ankle and up. The pain last for a day or so, it's back to normal after a break.

Now I dont know if its my trainers, I have 2 pairs, these: http://www.sportitude.com.au/shop/product/nike-lunar-forever---womens-running-shoes---blackblue

and these (yes I can fit in kids shoes haha) : http://www.johnlewis.com/asics-children's-gt-1000-4-gs-running-shoes/p2481343

Both give me this pain. I decided to go and get a gait analysis (one here in the UK and one in New Zealand) and I had different outcomes. 

My first analysis using a tradition treadmil and filming software told me that I was a neutral runner but I am flat footed. They recommended me a neutral shoe with hard support at the back of the ankle.

My second analysis using a treadmil, pressure tracking and eyes to view my gait told me that I had a high arch (I dont believe this because this was done on a pressure pad and when I stand most of my weight is put on my heel and not enough pressure is put on my foot which is screwing the data. So it looks like the rest of my foot isnt even touching the fall) She also said I have some pronation on my right foot (eye assessment). So I bought the recommended shoes (second pair) here.

To save time and potential injury, I am going to book in to get a biomechanical assessment from an osteopath. Waiting for physio from the NHS will take too long and I feel I will cause some serious damage if I wait and keep running. 

Does anyone else have this issue?

Thanks

Hayley

[JohnRi]

Unfortunately pain is our body's way of saying we are doing something wrong. 

My guess is it's your shoes, but it might also be your mechanics of running. Which the wrong shoes can make worse.  Running is very hard on the body.  I prefer walking.  A lot less stress on the body.  You might consider running less, and power walking more.  You have to walk twice as long to burn the same calories as running, but it's less stress on the bones, tendons, and ligaments. 

I tried going from power walking to running, and proceeded to get several injuries, and was forced to give up running all together for now.  I may try again, once I lose another 40 lbs.... 

Good luck.

[shipo]

I have a few comments; hopefully you will find at least some of them helpful:

• I am the co-captain of our company running club and active in another local running club and help to coach runners, both beginner and experienced.  One of the most common injury related issues I run into is what I call "TFFFS" (Too Far, too Fast, too Frequently, too Soon).  The thing is, the muscular, respiratory, and circulatory systems develop fairly rapidly, however, bones, joints, and all of the connective tissue take a heck of a lot longer to develop.  What I tell the new runners I work with is, "Just because you have the strength and endurance to run X miles or XX minutes, doesn't mean you should, yet."
• For new runners I advocate LSD (Long Slow Distance); for at least the first six to twelve months (preferrably longer), if given the option of running say 3 miles in 30 minutes, or a slower/longer run of say 4 miles in 45 minutes, do the latter.  Using LSD as the basis for your training will allow your connective tissue and your bones to develop in such a way as to help you avoid injury.
• In your case, shoes may well be an issue and getting at the very least a good analysis of your foot shape and running style is important.  That said, you really don't need a bunch of "professionals" do to that for you (some are good, most...).  I would suggest you do something simple like put a piece of paper on the floor, wet each of your feet, and stand on the paper.  If the paper shows a wide contact area then you probably have flat(ish) feet.  That said, if the mid-foot contact area is less than say half the width of the forefoot area, your feet are pretty normal, and finally, if there is very little mid-foot contact area, then you have high arches.
• Based upon what you wrote, it sounds like you're suffering from some form of tendonitis; I would recommend you limit (time/speed/distance) your running to keep things under your threshold of pain.
• One final suggestion; if you can find a place to run on dirt or grass as opposed to some form of pavement, that will pay huge dividends.

[Ukase]

@shipo

That's some helpful advice. I have no idea if it helped the OP - but it sure helped me! 

[brerbill]

Shipo is right on with his observations, and in the most likely order, as well.

When, as a new runner, you say "...it's been a hard journey...", you could be guilty of "TFFFS", like many runners have been, myself icluded. It does take much longer for your muscles, ligaments, tendons, etc. to acclimate to those new stresses than people think. Meanwhile, make most of your runs "easy runs", and rest (take time off from running if you feel pain). Not forcing things, having patience, and limiting injury will go a long way in helping you be successful.

My suggestion is to follow a beginning running plan like C25K ("Couch to 5K"), which is not a race-spcific traing program, as most running plans are. The great thing about this program is that you can start at your own current level of fitness, but you can also 'step back' a week or more in the plan if needed. Sounds like you would fit in around the middle-to-last part of it. This program will also help you develop a schedule that works for you, and that's critical. When you can finish that, and if interested, try a longer plan, or a 5K Race training program (Hal Higdon's plans come to mind). Join a running group.

Good luck!

[HybridHayley]

Thanks for the advice. I appreicate it.

I have been and got 2 gait analysis and they have both given me advice which were totally different. I feel buying my third pair of running trainers will be a waste of money therefore I have booked myself in to get a biomechanical assessment who can properly idenify what I am doing wrong.

In terms of going too hard too quick. I have been following the Couch to 5k NHS podcast and I am on my last week (9) and to accommodate this I am going to try some strength training and yoga to help with building up the surrounding area. I do runs 3 times a week and rest for the days I am not. I will not run if my ankles are painful, I wait till they are fine and then do it. My last run was Sunday, so I am going for another today and see how it goes.

I do feel it maybe a shoe thing but having opinions like "you're a neutral runner" to "you pronation" I am very confused hence the hestitation to buy yet another pair of shoes. That being said, I will try the wet feet things tonight. One gait told me I was a flatish foot (which I know) but I am a neutral runner... so in terms of a suitable shoe I am very confused as isnt having a low arch make you overpronate?

I think I might cut down the runs to 20 mins or when I start to feel discomfort and keep it steady. I am running about a 11-12 min mile so its hardly fast.

Thanks for the suggestions, I will try and keep them on board when deciding to run again. 

[shipo]

A few more comments:

Regarding your running style; your shoes often tell the best story.

• If you look at the wear pattern on the sole of your shoes and see a primarily fore/aft wear pattern with no significant bias to either side, you are a neutral runner.  Keep in mind, if you see, say the pattern biased a bit toward the outside of the heal and a bit toward the bit toe area, that constitutes "neutral".
• If you see a heavy wear pattern on the inside of the sole, that constitutes "pronation".
• If you see a heavy wear pattern on the outside of the sole, that constitutes "under-pronation/supination".

When you say 11-12 minutes is "hardly fast", I would beg to differ.  Consider the following:

• When I race, say a 5K, my pace is typically in the high six to low seven minute range (depending upon conditions, the course, and my training), when I run races say in the ten mile to half marathon range, I typically run an average pace in the high sevens.  So?  Funny thing, when I train, my pace is all over the map, just today my average pace was 11:14 with my fastest mile being 10:33 and my slowest mile being 12:31.  My advice to you would be to slow it down a bit and run more like thirteen minute miles; when that becomes too easy, and when you can run your normal distance with no pain, then instead of speeding up, extend your distance.  I would suggest you stay at that thirteen minute pace until, at the very least, you can run six miles with no pain before you start speeding things up.

[HybridHayley]

I dont think my trainers are the best to go by from looking at the sole. Both apparently have some sort support in it so it could be throwing my running off either way.

I have however included my daily work shoes which are totally flat. I have been wearing these since October. From past observations from wearing other shoes, I tend to wear the heel down pretty quickly over the past 12 months. As you can see the white outlines are now visible and were not viewable when I bought them.

My left foot suprisingly which is the worst one for problems has more wear than my right.

 *Such to note, I never get this pain while walking, only running for longer than 15-20 mins. It seems to be linked to repeatitive movement aggravating it while running*

The grass option might be a good idea. 🙂

Any opinions?

I will take in consideration about the speed. 13 minute miles are very slow for me and i feel like I am running at a comfortable speed.My last run was an average 10.36 minute per mile for 16 mins with no pain apart from I nearly sprained my ankle tripping so I think I might drop it down to 12 minute per mile and see what happens and see how I feel.

Thanks for the suggestions! Really Appreicate it.

[shipo]

Looking at the soles of your shoes I see a slight pattern from the outer heel to the inner toe box; a very common pattern and one which typically qualifies the individual as a "Neutral" runner.  That said, I've seen folks with very different patterns when comparing their walking shoes with their running shoes.

Regarding your pace, slowing to a 12 minute mile is a good start, however, I would suggest to slow it a bit more and shoot for a longer duration run of say 20-25 minutes, and if that feels both A) easy, and B) pain free, stay at the slow pace and extend your time even further.  As I wrote above, once you can comfortably go six miles pain free, then it's time to start speeding things up a bit.

Another comment on pace; I know how hard it is to slow down to what seems like a crawl, I mean, it took me years to develop the disipline to force myself to keep things slow until I was able to accomplish a pretty fair distance.  Even still, I may never have developed said disipline if I hadn't suffered a badly broken leg and partially detached foot which kept me away from running for over six years (during which time I gained 100 pounds).  When I finally started successfully running again (after years of painful failures) I started with a half-mile twice a week on dirt or grass; I logged a whopping total of 8 miles the first month.  The good news was those were the first pain free (errr, "bad" pain free, I had plenty of "good" pain) miles I'd run since before the incident with my leg.

[Corney]

Bio-mechanics.  The Tibialis Posterior is a muscle that gives support to the arch of the foot.  Most likely your arch falls when you run.  This tendon runs through a tendon sheath bathed in synovial fluid which allows the tendon to move freely.  If the tendon is over stressed it will swell up and not move freely in this sheath.  If the pain is only on one foot, that leg maybe slightly longer that the other leg, causing the foot to Hyper-pronate which in effect shortens that leg, because your body wants to be symmetrical. My suggestions are, stretch the calf muscle by doing wall push ups, purchase an over the counter orthotic and buy shoes that have a strong heel counter that gives your feet good rear foot stability.  If it is only one foot a heel pad in the shorter leg can also help.  My Son has very flat feet, he and his wife were in Las vegas a few week ago and the did alot of walking, he wore sandals.  After they came back, he exhibited the same symptoms as you.  I gave him the same advice, he stretches his calf muscles, purchased an over the counter orthotic( which I probably can't name because this site may think I'm advertising a specific brand, I've used the same orthotic forover 20 years and my Plantar fasciitis has never returned) .  Also purchase shoes with a firm heel counter to give you feet good rear foot stability.  He followed my advice and one week later he is symptom free, stops going bare foot around the house and uses the orthotic in all the shoes that he does alot of walking.  I seriously doubt you have a high arch, you my have a neutrl foot when standing, but I bet when you run your  arches fall because when you run you land with 3x body weight, because of this any biomechanical problem is exacerbated when you run.  Good luck in your search for a cure!

[HybridHayley]

Thanks for all the replies, I had a feeling it was the Tibialis Posterior giving me grief.

UPDATE 🙂

Results from the Biomechanical Assessment.

So basically the cause for my pain is related to the fact I am hypermobile. Due to my tendons being very flexible it is causing my arch to collasp and my foot to pronate slightly. I am relatively straight in terms a standing foot position. Now this isnt a bad thing as my current footware are helping with both. My real issue is because my Tibialis Posterior muscle is weak and doesnt have much endurance its crying out because its over worked, I never have any pain until I run. If I am applying 3x my body weight on a tendon that struggles already to support my arch then no wonder it hurts. She dug her thumbs in my deep muscle within the calf and boy thats sensitive. The right one not so much.

She confirmed that my tendon is working fine and I havent done any damage to it.

So I am flat footed with pressure and I also am a heavy heel striker with a slight rotation on the ball of my foot. 

The plan of action:

I have to take a few steps back and start building that muscle up with my runs giving ample recovery time. 

15-20+ mins through a run I start to feel pain so she recommended running for 15 mins x 3  then giving myself 3 days of recovery. I then reduce the recovery times by a day until I have a only 1 day recovery. If everything isnt hurting I then increase the time I spend running then repeat the process of 3 day recovery reducing that down to 1 until I can run for 30 mins without pain. If it does start hurting through the run, stop, give it rest and some attention then try again 3 days later. 

I need to do muscle conditioning pre and post run which includes a good warm up and warm down. After each run I also need to do appropiate stretches and apply ice to the area and give it physio and heat through the rest days, not looking forward to digging my thumbs in an already sensitive muscle.

Within the recovery times, she has advised me to do Tibialis Posterior exercises to start strengthening the muscle, she recommended heel raises hold for 5 and release slowly for 5 x10 reps which should help. 

If I feel I need extra support she said I could tape my foot (showed me how).

AND... I get to buy some new walking shoes. The ones I wear are not supportive enough for a flexible foot. Best £65 I have ever spent. I got so much information and a clear understanding what is going on and how I can help it.

Thanks to everyone who added to the form.

[Corney]

You can strenghten the Tibialis Posterior all you want, but thats not going to fix the bio-mechanical problem which is a weak foot.  If you don't get an orthotic that gives your arch adequate support your problem will persist.  It's good that you got shoes with a firm heel counter.  The orthotic will eliminate the need to continue taping your foot.  Good luck.

[HybridHayley]

I am not taping it, the tape is for extra support if I feel I need it.

I also have arch supporting trainers which supports my arch, she looked at my running when wearing them and said they have good support which limits me pronating. So they do the job, I am just over working the muscle. 

[Corney]

I won't belabor the point, but if you are overworking the muscle then the arch support in your shoes is not doing enough to support your arch.  If you are a heavy heel striker, at midstance that increased momentun is causing your foot to roll more inward causing increased pronation, causing the Tibialis Posterior muscle to overwork trying counteract that motion that flattens your arch.  Simply put if you are overworking the muscle your shoes are not giving you enough arch support.

[shipo]

I'm thinking if you truly are a "heavy heel striker" you may want to revisit my comments earlier on in this thread regarding slowing down.  One of the common issues many of the beginning runners I work with have, which is almost always associated with running too fast for their conditioning, is heel striking.

If you look at slow motion videos of elite runners, you will see their heels "touch" first, but that's all it is, a touch.  There is no significant weight placed on the foot until the middle of the foot is already on the ground.  I tell my runners to go slow enough to "stay over your feet"; long story short, if any real weight is being placed on your feet while they're still in front of your head and shoulders, you're overstriding; a condition which will result in injury sooner than later.

[akshayv]

I've experienced such intense foot pain that in the past I had to curtail my gardening activities. These shoes have given me back my gardening life. I can now stand again for hours without discomfort. Orthofeet are definitely not the most attractive shoes I've ever had, but they are qualitatively the most comfortable walking shoe I've ever put my feet into. The shoes were true to size, and were "out of the box" comfortable the first time I put them on. 

[trustinbeing]

Fantastic improvement! I don't have time to read the thread but FIND A GOOD PHYSICAL THERAPIST that has worked for me!! Good luck! I kow this was a while ago, hope it is resolved!

[Corney]

trustinbeing: Your problem is most likely due to a bio-mechanical fault
due to a weak transverse arch. The Tibialis Posterior tendon that run
behind the medial malleolus just anterior of the Flexor Digitorum muscle
and attaches to the Navicular and underside of the Medial Cuneiform bones.
This muscle acts as Plantar Flexor and inverotr of the foot but also
provides supportg to the transverse arch. if you have a flat foot or the
arch is weakened this muscle tries to continue to give support to your
arch, when this happens the tendon becomes inflamed causing tendonitis.
Treatment: stretch the posterior muscles by doing a wall stretch, ice the
medial ankle area after running and give your arch more support with
commercial arch supports. Good luck!

[in-training]

This thread is exactly what i am experiencing.

I've been following the c25k, app and am now at week 7, running consistantly for 23-25mins, and adding a few mins each week going forward.

Everything was going well untill i did 3, 23 min runs in a week. so i took a week off, rested, felt ok so went back out today( in new trainers)...... 8-10 mins in, sore ankles again L>R.

I thought it could have been my trainers initially and too much running in one week, so i got gait analysis and new trainers with orthotics, high arches L>R, with right foot pronation, left straight. 

I thought the arch support would 'fix' the problem, obviously not.

So, going by the above advice i understand this;

1.i should use arch support in my everyday shoes.

2. i need to slow down, (currently running ave 6mins/km)

3. do some strenghthening exercises for my ankles and feet.

4.anything else?

A few questions;

If i feel no pain walking, how long should i rest up before running again?

Is it possible i need more arch support when running or is this counter productive?(i dont 'feel' the arch support in the left foot but am 'aware' of it in the right)

So glad i found this thread, it has been invaluable, and possibly saved me troubling the nhs physio again (have a shoulder/elbow/wrist issue) thank you for the advice.

[Corney]

in-training: Is the inner ankle pain only in the right foot? If you have
high arches you shouldn't need arch supports. Over pronation will cause
your arch to fall. Check your leg lengths, if one leg is longer that will
cause over pronation in the longer leg. if you run on the road, roads are
are usually banked, running toward traffic will cause the right leg to be
longer, running with traffic will cause the left leg to be longer.
Tibialis Posterior tendonitis is a bio-mecanical fault caused by a weakened
transverse arch. Fix the problem you will decrease your pain.