Nov 1, 2021
Pain & Injury

Why Do My Ankles and Feet Hurt When I Run?

Why Do My Ankles and Feet Hurt When I Run?

Why do my ankles hurt when I run?

To be honest, this is not a simple, cut and dry question to answer. There are a bunch of reasons why someone’s ankles hurt when they run, including:

  • Sprains
  • Strains
  • Stress fractures
  • Tendinitis
  • Incorrect running form
  • Foot pronation or supination
  • Plantar fasciitis
  • Muscle weakness
  • Muscle tension

While this list doesn’t encompass everything under the sun, these may all have a common culprit. If you’re experiencing more than one from this list, it may be because they’re more interconnected than you thought!

For instance, muscle weakness can lead to muscle tension in other muscles, due to overcompensation. Then, that muscle tension can lead to misalignment and incorrect running form, and eventually tendinitis.

And that could lead to an ankle strain or sprain, or even a stress fracture.

From personal experience of over 20 years as a physical therapist working with runners, one of the most common reasons people have ankle pain while they run is because of muscle tension in the hip flexors. Yup, tight hips when running are trouble.

Most people don’t even think to consider that part of the body but - like I said - it’s all interconnected. Let’s take a closer look at how...

Your hip flexors: powering each stride

When we are addressing pain, we often start by addressing the initial symptom. If you’ve been here for a while, you know I’m all about finding the cause - and creating habits that prevent the pain in the future. Often, it means looking to other parts of the body that could be triggering your ankle pain when running.

Even though you are worrying about why your ankles hurt when you run, your ankles might not be the main issue at all. In fact, they’re probably not.

It’s probably coming from higher in your legs, knees, or hips. And I’d be willing to bet on the latter.

It can be hard to imagine how an issue in your hips can make its way all the way to your ankles, but it is all by a network of muscles that start in your hip flexors. Your hip flexors, or iliopsoas muscles, are actually two muscles: the iliacus and the psoas, and it’s important to understand how they work.

The iliacus sits on the inside of your pelvis bone, comes down the front of your hip, and connects to the front of your thigh bone. The location of your iliacus is very close to the hip joint, which is why it’s common to feel hip pain or tension if this muscle has become overworked.

The psoas starts its upper attachment on the diaphragm and has a tight grip on your entire lower spine. Moving down, it crosses the iliacus and attaches to the same spot on the front of your thigh bone.

Your hip flexors earned their name because they flex your hips. These muscles are quite literally the reason you can create the forward and backward movements of your legs while running.

Hip flexion is when you move your leg forward, like when you step forward or up when you are running. And hip extension is when you bring your leg behind you. Your leg isn’t bearing any weight in this position, but it’s still indirectly engaging the iliopsoas muscle.

So, for every running stride length you take, you are engaging the iliopsoas. For proper hip alignment and the best running form, the iliopsoas needs to be flexible enough to stretch into a full leg extension while running, but taut enough to pull your leg back into position.

But that’s not all.

These muscles also work round the clock to stabilize your spine, keeping it in the correct position and alignment relative to your pelvis. And this doesn’t just impact your ability to run.

What happens when your hip flexors stay tight?

Start to think of your hip flexor muscles like a new rubber band or hair tie, quickly and easily moving back to its original shape. Just like a rubber band, prolonged activity, improper or overstretching, infrequent stretching, and more makes it very easy for these to become stressed and/or worn out.

When they are stressed, they may not release their hold on your bones and joints - creating tight muscles and joint issues. But the same happens when they are fatigued. Your hip muscles actually work harder when they are tired, and that causes them to apply more force than is needed to our joints.

Both options lead to the same issue: tight hip flexor muscles.

And this is the beginning of the dominos. The first piece to fall. Because when your iliopsoas is tight, the other muscles in your hip and pelvic area won’t align properly. The tightened muscles will also shorten, pulling unnaturally on your thigh bone and knee joints.

This causes everything else down the line to topple out of place.

As these dominos fall, it can cause your thigh bone to rotate inward, stretching and straining the inside of the knee.

Eventually, nearby structures like your MCL (medial collateral ligament) and your thigh adductor muscles become more strained and inflamed. The continuous stretch on the inside of your knee puts more pressure on the outside of the knee as well.

The twist of your knee now can strain your meniscus and make it harder for your knee to absorb shock and keep the knee stabilized. (This is why you may be having knee pain after running too.)

Pronation in runners

The internal rotation of your leg can also turn into a twisted ankle or a flattened foot. As the ankle turns inward, your foot naturally becomes flatter. When your foot and ankle are in this position, you are at higher risk of injury and strain to your knees, hips, ankles, and feet.

If the bones in your foot aren’t lining up properly, this will cause wear on the ankle over time and the Achilles tendon can also become strained.

When the foot is twisted into a flattened position, it causes something many runners may already be aware of called foot pronation, which brings your weight more towards the inside of your foot every time you step. When this happens, the bottom of your foot is easily irritated and can quickly develop into running feet, plantar fasciitis, or even bunions.

Now you can see how the answer to the question: “why do my ankles hurt when I run” could actually be your tight hip flexors - even if your hips are showing no sign of tightness or pain. The issues may be manifesting in other parts of your lower body, but it can usually be traced up the leg and into your core.

illustration of excessive foot and ankle pronation

How to prevent ankle pain after running

If your hip flexors are causing you to ask “why do my ankles hurt when I run?” then it’s time to solve the real problem - not just the symptom. And it starts with establishing proper hip alignment.  

Realigning your hips can be broken into three parts:

  • First, address the muscle tension from all angles.
  • Second, implement gentle daily realignment exercises.
  • Third, be consistent with your running recovery routine.

Depending on the severity of your hip flexor tightness or how long your body has gotten used to operating out of alignment, each of these steps will take a different amount of time.

It doesn’t mean your ankle pain from running will go away overnight, but you might be surprised at how quickly symptoms begin to subside. I have seen iliopsoas releases that bring some instant relief!

The important thing to keep in mind is to be patient and understand this is a process.

Treating tight hips for runners

Have you ever had hip pain after running? Did that pain appear before or after your ankle pain appeared?

If you did, targeting your iliopsoas muscle tension will help you address several pain points.

The best way to address muscle tension is by applying prolonged pressure. When you apply pressure for at least 30-90 seconds, it gives the mechanoreceptors in your muscle tissue enough time to send signals to your brain and tell it to stop holding tension in the area.

That’s why if you skip the muscle pressure release and go right to stretching, you get fewer results. The muscles will still retain tension and it will be a bit like trying to stretch an impossibly tight rubber band.

To reach these muscles for a full pressure release, one way is to work with a manual therapist to help you. Or you can release these muscles at home, using a precision tool designed to reach these pressure points. The Hip Hook is currently the only muscle release tool that targets your psoas and your iliacus muscle to release tension. It does this by using specific angular pressure in hard-to-reach locations.

woman using the Hip Hook tool to release tight hip flexors

To use the Hip Hook, first locate the soft spot just inside of your pelvic bone. This where your psoas and iliacus muscles live. Once you’ve found this spot, lay on the Hip Hook, letting it sink into the psoas for about 90 seconds. Once the psoas has had time to relax, you can push the lever on the Hip Hook to push into the iliacus muscle and pin it against your ilium. Continue to apply this prolonged pressure for another 90 seconds.

Listen to your body and pay attention to the sensitivity you may have in this area. Staring out with less time at first and working your way up to longer sessions is perfectly okay, and even encouraged!

If you know your hip flexors are extremely tight, or you’re not accustomed to pressure in this area, you may choose to start with the Hip Release Ball. The size and firmness of the ball are perfect for warming up this area for more direct pressure with the Hip Hook. While the ball won’t be able to access your iliacus, it provides broad pressure to the psoas muscle: the size and density ensures that it doesn’t get lost in your abdomen and will be able to help release this muscle. It can also be used to release the back of your hip and the piriformis muscle.

Realignment exercises to add to your routine

Once the tension has been released, you still need to start working your pelvis back into alignment so the rest of your leg can track straight again. To do this, perform realignment exercises after you use the Hip Hook.

Unlike the muscle tension release tools, you should only perform the realignment exercise on the side of your hip that is being pulled out of alignment. Here is how to perform the realignment in 10 simple steps:

  1. Lay on an even flat surface on your back.
  2. Bring your knees up towards your chest. Your feet should be off the ground.
  3. Place one hand behind the knee on the side of your hip you are realigning. This is the side that has more tension and is being pulled forward (also likely the side of your body that has ankle pain).
  4. Squeeze your hand behind your calf muscle by bending your knee towards your butt and the floor.
  5. While you do this, moderately push against your hand without moving. It should feel as if you are attempting to push your foot towards the ground.
  6. As you push, the hand holding your leg will resist the pressure. Do not press too hard, just enough to feel some force.
  7. Your opposing leg should stay off the ground but in a neutral position.
  8. Hold the pressure and pushing motion for two seconds.
  9. Relax for a few moments.
  10. Repeat the cycle of pressure and relaxing 10 times.

Consistency is key

As a runner, you know that you won’t go from your couch to running marathons after one training session. Well, the same can be said for running recovery and alleviating that ankle pain.

Once you’ve answered the question, “why do my ankles hurt when I run?” and you’ve narrowed down the root cause, then you can start to take on a consistent, daily running recovery routine.

When I say daily, I mean daily! When it comes to ankle pain that is caused by muscle tension, it will take time for your muscles to learn to relax.

Using tools like the Hip Hook and Hip Release Ball are very effective in training your muscles to release tension, but only if you practice the steps provided above daily.

The good news is that these running recovery tips can fit right in with your running routine and only take 10 minutes. They won’t be adding an exorbitant amount of time to your workout schedule - and they are likely to make running more pain-free and enjoyable with time.

FAQs about ankle and foot pain while running

Should I stop running when my ankles hurt?

First, rest and treat the immediate pain. Then, address the root cause of the pain which may include tight hip flexors which are changing the overall alignment and stress on your ankles.

How do runners strengthen their ankles?

There are exercises you can do to strengthen your ankles, including calf raises.

How to do a calf raise:

  • Stand with your feet hip-width apart at the edge of a step with something to hold onto for balance (i.e., a railing). If you don't have access to stairs, you can do this on a flat surface.
  • Raise your heels up so you are standing on your toes.
  • Lower your heels down.
  • Repeat 10 times.
  • Do it once per day.

Working with a physical therapist will help give you targeted exercises to strengthen your ankles.

How can I fix runner’s foot?

Runner’s foot is the degeneration of the fascia (thick layer of tissue) on the bottom of your foot. If there is increased pressure on the inside or outside of your foot, this can be creating the problem. Look up the chain to tension in your hip flexors as a possible culprit.

var h1 = document.querySelectorAll('h1'); if (h1.length > 1) { for (var i=1; i< h1.lenght; i++){ h1[i].parentElement.removeChild(h1[i]) } }