The ankle is a complex joint consisting of seven bones that connect the two shin bones to the five metatarsal bones of the foot. As the site of some 750 flexion and extension movements, on each side, per mile of running, it is subject to significant biomechanical stress. Injuries to the inside of the ankle may involve ligaments, tendons, bones or the sheath surrounding all of them.
Posterior Tibial Tendinitis
The posterior tibial tendon runs down the inside of the leg, passes under the medial malleolus, and attaches to the navicular bone. Its job is to support the arch of the foot. When subjected to excessive stress, the tendon becomes inflamed. Most runners who incur this injury overpronate or have flat feet. Treatment includes ice, stretching the calf, anti-inflammatory medications, sticking to level surfaces when running, and wearing rigid, supportive shoes rather than soft, flexible models. Orthotics to help support the arch are useful in many cases.
Sprain
According to podistrist James Losito, ankle sprains represent the most common injury among athletes. While the vast majority are inversion sprains, which involve the outside of the ankle, eversion sprains account for about 10 percent of ankle sprains and are therefore still common given the prevalence of ankle sprains in general. A sprain of the inner ankle is treated the same way as an inversion sprain -- rest, icing, elevation of the lower leg, compression and anti-inflammatory drugs. If the ligaments are sufficently damaged, you may require a cast.
Tenosynovitis
Ankle tenosynovitis is an inflammation of the sheath surrounding the tendons that pass through the joint from the shin to the foot. In runners it most often occurs as a result of overuse, although an injury to the area accompanied by infection can also cause tenosynovitis. Primary symptoms include pain on flexion or extension of the ankle and redness along the length of the affected tendon or tendons. Anti-inflammatory drugs, cortisone shots, immobilization and sometimes surgery are the mainstays of treatment for tenosynovitis.
Stress Fracture
The tibia is the more weight-bearing of the two shin bones and is a very common site of stress fractures -- cracks in a bone that occur as a result of chronic overload rather than as a consequence of trauma. According to the Sports Injury Clinic, the most frequent location is 2 or 3 inches above the medial malleolus, the "bump" on the inside of the ankle. Tenderness, swelling, and pain -- particularly after a longer run and when pressing on the area -- are the chief symptoms of a stress fracture, which in runners almost always results from too many miles. Treatment includes a six- to eight-week rest period followed by radiography to confirm healing of the bone.
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