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

Why Inner Ankle Pain in Runners Is a Distinct Problem

Medial (inner) ankle pain in runners is different from the more common lateral ankle pain associated with sprains. The inner ankle contains important structures — the posterior tibial tendon, tibial nerve, medial ankle ligaments, and the navicular bone — and pain in this area often signals conditions that won’t resolve with simple rest. At Balance Foot & Ankle in Howell and Bloomfield Township, we help runners identify the specific cause of their medial ankle pain so they can address it correctly.

1. Posterior Tibial Tendinopathy (PTTD)

The posterior tibial tendon is the primary dynamic support of the arch, running down the back of the medial leg and around the inner ankle to attach to the navicular and other midfoot bones. In overpronating runners, this tendon is chronically overloaded. Pain is felt behind and below the medial malleolus (inner ankle bump), worsening with running and often with single-leg heel rises. Early PTTD responds well to orthotics, calf stretching, and activity modification. Delayed treatment can lead to tendon tearing and progressive flatfoot deformity.

2. Tarsal Tunnel Syndrome

Compression of the posterior tibial nerve in the tarsal tunnel causes burning, tingling, and numbness on the inner ankle and sole of the foot. Runners with flat feet are particularly susceptible — the collapsed arch creates tension on the nerve. Tapping over the tarsal tunnel (Tinel’s sign) often reproduces symptoms. Treatment includes orthotics to support the arch, nerve gliding exercises, and in persistent cases, cortisone injection or surgical decompression.

3. Navicular Stress Fracture

The navicular bone on the inner midfoot is a notorious site for stress fractures in runners — among the most serious of all running-related stress injuries because of the bone’s poor blood supply and risk for non-union if inadequately treated. Pain is vague and medial, worsening progressively with running. The “N-spot” — point tenderness directly over the navicular — is a classic finding. MRI confirms the diagnosis (X-rays are usually negative). Treatment requires 6 weeks of strict non-weight-bearing.

4. Medial Ankle Ligament Sprain

The deltoid ligament complex on the inner ankle can be sprained by forced eversion (foot turning outward). This is less common than lateral ankle sprains but occurs in sports with lateral cutting movements. Signs are tenderness over the deltoid ligament, swelling, and pain with eversion stress. Severe deltoid sprains warrant X-rays to rule out associated fibular fracture (the classic “high ankle sprain” pattern).

5. Flexor Hallucis Longus Tendinopathy

The FHL tendon runs behind the medial malleolus and under the foot to the big toe. In runners — particularly those who also do ballet or plyometric training — it can become inflamed at the point where it passes behind the talus. Pain is medial and posterior, worse with big toe push-off. FHL tendinopathy is often confused with posterior tibial tendinopathy but can be distinguished by which movements reproduce the pain.

6. Medial Tibial Stress Syndrome (Shin Splints)

When shin splints affect the medial distal tibia, pain extends along the inner lower leg and may be perceived as ankle pain. The distal third of the tibia is the most common location. Pain is diffuse rather than focal, worsens progressively during runs, and is tender along a stretch of bone rather than at a specific point. Treatment involves training load reduction, orthotics for overpronators, and progressive return to running.

Getting Accurately Diagnosed

Because these conditions have overlapping presentations, clinical examination combined with appropriate imaging (X-ray, MRI) is essential for accurate diagnosis. If you have inner ankle pain that persists beyond 2 weeks of running, contact Balance Foot & Ankle for a runner-specific evaluation.

Foot or Ankle Pain? We Can Help.

Balance Foot & Ankle — Howell & Bloomfield Township, MI

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Pain on the Inside of Your Ankle While Running?

Inner ankle pain during running often involves the posterior tibial tendon, which supports the arch and controls pronation. Without proper treatment, this can progress to adult-acquired flatfoot. At Balance Foot & Ankle, we diagnose the specific cause and create a targeted recovery plan.

Learn About Flat Foot and Arch Support Treatment | Book Your Appointment | Call (810) 206-1402

Clinical References

1. Kohls-Gatzoulis J, et al. Tibialis posterior dysfunction: a common and treatable cause of adult acquired flatfoot. BMJ. 2004;329(7478):1328-1333.
2. Rabbito M, et al. Biomechanical and clinical factors related to stage I posterior tibial tendon dysfunction. Journal of Orthopaedic & Sports Physical Therapy. 2011;41(10):776-784.
3. Kulig K, et al. Nonsurgical management of posterior tibial tendon dysfunction with orthoses and resistive exercise. Clinical Biomechanics. 2009;24(2):164-169.

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.