Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

The Medial Ankle: More Than Just Sprains

Lateral ankle sprains — injuries to the outer ankle ligaments — are far more common than medial ankle injuries, which can lead patients and providers to overlook the medial ankle as a source of pain. The medial (inner) ankle houses critical structures: the deltoid ligament complex (the primary restraint to valgus ankle stress), the posterior tibial tendon and other tendons passing behind the medial malleolus, the posterior tibial nerve and its branches (important for foot sensation), and the medial ankle joint capsule. Each of these structures produces characteristic pain when injured or diseased. At Balance Foot & Ankle in Howell and Bloomfield Township, Michigan, we evaluate medial ankle pain systematically to identify the specific structure involved.

Deltoid Ligament Injury

The deltoid ligament — a fan-shaped, multi-layered ligament connecting the medial malleolus to the talus, calcaneus, and navicular — is the primary restraint against valgus (eversion) stress on the ankle. True isolated deltoid ligament tears are rare because the deltoid is much stronger than the lateral ankle ligaments. When deltoid injury occurs, it typically accompanies fibular fractures (the classic bimalleolar fracture pattern). Clinical features: medial ankle swelling and tenderness after an eversion injury, pain with weight-bearing. X-rays should be examined for widening of the medial clear space (indicating instability). Significant deltoid tears with ankle instability may require surgical repair.

Posterior Tibial Tendon Pathology

The posterior tibial tendon — the primary dynamic arch support — runs immediately behind the medial malleolus in a groove. Posterior tibial tendinopathy produces medial ankle pain and swelling along the tendon course, pain with resisted inversion, and difficulty with single-heel-rise (rising on one foot’s toes). This is the medial ankle condition most frequently seen in podiatric practice and is the leading cause of adult acquired flatfoot. Early diagnosis and treatment (immobilization, orthotics, physical therapy) can halt or reverse flatfoot progression that untreated becomes a major surgical problem. Ultrasound at the office allows real-time assessment of tendon integrity and guides injection if needed.

Tarsal Tunnel Syndrome

The tarsal tunnel — formed by the medial malleolus, calcaneus, and flexor retinaculum — houses the posterior tibial nerve and its branches (medial plantar, lateral plantar, and medial calcaneal nerves). Tarsal tunnel syndrome (posterior tibial nerve compression) produces medial ankle aching combined with plantar foot burning, tingling, and numbness in the sole and toes. A positive Tinel’s sign (electric sensation radiating to the foot when the nerve is tapped behind the medial malleolus) helps confirm the diagnosis. Electrodiagnostic testing (EMG/nerve conduction) documents nerve dysfunction. Treatment: orthotics to reduce nerve tension from pronation, targeted injection, or surgical nerve decompression in refractory cases. Contact Balance Foot & Ankle at (810) 206-1402 for medial ankle pain evaluation and systematic identification of the responsible structure.

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Balance Foot & Ankle — Howell & Bloomfield Township, MI

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When to See a Podiatrist for Medial Ankle Pain

Pain on the inside of the ankle has multiple possible causes including posterior tibial tendon dysfunction, deltoid ligament injuries, and tarsal tunnel syndrome. At Balance Foot & Ankle, Dr. Tom Biernacki provides a thorough evaluation with ultrasound and clinical testing to identify the specific source and create a targeted treatment plan.

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Clinical References

1. Bare AA, Haddad SL. Tenosynovitis of the posterior tibial tendon. Foot Ankle Clin. 2003;8(3):459-473.
2. Hintermann B, Valderrabano V, Boss A, et al. Medial ankle instability: an exploratory, prospective study of 52 cases. Am J Sports Med. 2004;32(1):183-190.
3. Ahmad M, Tsang K, Mackenney PJ, et al. Tarsal tunnel syndrome: a literature review. Foot Ankle Surg. 2012;18(3):149-152.

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Dr. Tom Biernacki, DPM

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Dr. Tom Biernacki, DPM

Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.