Pain along the inner, or medial, side of the ankle and foot when walking is a frequent complaint. This discomfort often arises because the complex structures in this region—including tendons, ligaments, and nerves—are being overworked or stressed by the repetitive motion of bearing weight. Pain aggravated specifically by walking or standing usually points toward a problem with the mechanical stability of the foot and ankle, often stemming from gradual overuse or underlying biomechanical alignment. Understanding the source of the strain is the first step in addressing this pain.
The Most Common Culprit
The most frequent cause of chronic inner ankle pain that worsens with walking is Posterior Tibial Tendon Dysfunction (PTTD). This long tendon runs from a calf muscle down the inside of the ankle and attaches to bones in the foot, acting as a primary stabilizer of the arch. Its function is to support the arch and prevent excessive pronation, or rolling inward, during walking.
When the foot excessively pronates or the tendon is overloaded through strenuous activity or obesity, it begins to strain and degenerate, leading to tendinitis or tendinosis. Early symptoms manifest as a dull, aching pain and mild swelling directly along the tendon’s path behind the bony bump on the inside of the ankle. Pain that increases as the day progresses, particularly after prolonged standing or walking, is a classic symptom, indicating the tendon fatigues under constant stress.
As the condition advances, the tendon loses its ability to support the arch, leading to a progressive flattening of the foot, often referred to as adult-acquired flatfoot. People may find it difficult to perform a single-leg heel raise because the dysfunctional tendon cannot lift the arch effectively. If PTTD is not addressed, the altered foot mechanics can lead to chronic pain and instability that limits mobility.
Nerve and Ligament Issues
While PTTD is common, inner ankle pain can also signal issues involving local nerves or ligaments, which present with distinct symptoms. One condition is Tarsal Tunnel Syndrome, involving the compression of the posterior tibial nerve as it passes through a narrow channel on the inside of the ankle. Unlike the deep ache of a strained tendon, nerve compression causes symptoms like burning, tingling, or numbness, often described as “pins and needles,” that can radiate into the sole of the foot and toes.
These nerve symptoms are intermittent and may worsen with prolonged standing or specific foot positions that increase pressure on the nerve within the tarsal tunnel. Another source of pain is an injury to the Deltoid Ligament, a thick, fan-shaped complex that provides stability to the medial ankle. This ligament is less commonly injured than those on the outside of the ankle, but a sprain usually follows an acute, high-force event, such as a severe outward twist of the foot.
A deltoid ligament sprain causes immediate, acute pain, bruising, and noticeable swelling around the inner ankle bone. Because the ligament is strong, a tear often occurs alongside other injuries, and the resulting instability can make bearing weight or walking difficult. Differentiating between the acute onset of a ligament sprain and the gradual, burning sensation of nerve entrapment helps narrow down the cause of discomfort.
Immediate Steps for Relief
For mild or recent inner ankle pain aggravated by walking, initial self-care can help manage symptoms and reduce inflammation. The RICE principle—Rest, Ice, Compression, and Elevation—is a standard approach to calm irritated tissues. Activity modification is important, meaning temporarily reducing the intensity or duration of walking and other weight-bearing activities that trigger the pain.
Applying an ice pack to the painful area for 15 to 20 minutes several times a day minimizes swelling and dulls the discomfort. Supporting the area with a compression bandage or an over-the-counter ankle sleeve helps control swelling. When resting, elevating the foot above the level of the heart aids in fluid drainage and reduces localized pressure.
Selecting appropriate footwear is an immediate, non-medical step that offers relief by reducing stress on the medial ankle structures. Choosing shoes with a firm heel counter and a supportive arch limits excessive pronation and provides a stable foundation for the foot during walking. Over-the-counter arch supports or supportive insoles can be placed into existing shoes to provide this mechanical benefit.
When Professional Medical Care is Necessary
While many mild cases of inner ankle pain resolve with simple home care, certain signs indicate a professional medical evaluation is necessary to prevent long-term complications. Seek attention if the pain is so severe that you are unable to bear weight or if the pain suddenly increases following an injury. Visible deformities, such as a rapidly progressing flattening of the arch, warrant an immediate consultation.
If the pain and swelling persist for more than two weeks despite consistent use of rest, ice, and supportive footwear, consult a physician, physical therapist, or podiatrist. Symptoms suggestive of nerve involvement, such as persistent numbness, tingling, or a burning sensation that does not resolve, should be promptly evaluated. Early and accurate diagnosis of conditions like PTTD or Tarsal Tunnel Syndrome often leads to effective non-surgical treatment plans and a faster return to comfortable walking.