Pain on the inside of the ankle, also known as the medial ankle, is a common complaint that can significantly impact daily activities. This complex area houses various structures including tendons, ligaments, bones, and nerves. Discomfort in this region can arise from a range of issues, from overuse injuries to more acute conditions.
Tendon-Related Causes
The posterior tibial tendon is a frequent cause of medial ankle pain. This tendon extends from a calf muscle, wrapping behind the inner ankle bone, and attaches to bones in the midfoot. Its primary role is to support the arch of the foot and assist in foot movement, especially during walking and push-off.
When this tendon is subjected to excessive stress or overuse, it can become inflamed, a condition known as posterior tibial tendinitis. Over time, if untreated, this inflammation can progress to degeneration of the tendon fibers, a chronic condition called posterior tibial tendinosis. The umbrella term for these issues is Posterior Tibial Tendon Dysfunction (PTTD), which impairs the tendon’s ability to support the arch, leading to its gradual flattening. Early symptoms often include pain and swelling along the inner ankle, particularly during or after activities like walking or running. As the condition advances, an inward rolling of the ankle may become noticeable, and difficulty performing a single-leg heel raise can occur.
Flexor hallucis longus (FHL) tendinitis is another tendon issue affecting the medial ankle. The FHL tendon connects a calf muscle to the big toe, allowing for its flexion and assisting in movements like standing on tiptoes. Inflammation of this tendon can cause pain on the inside of the ankle that may radiate to the big toe. This condition often develops gradually due to repetitive movements, such as those performed by dancers, rather than from a single traumatic event. Swelling and tenderness behind the inner ankle bone may also be present.
Ligament and Bone Issues
The deltoid ligament, a strong, triangular-shaped complex on the inner side of the ankle, helps stabilize the ankle joint and prevents the foot from turning excessively outward (eversion). A sprain of this ligament typically occurs from an eversion injury, where the foot twists outward, or from direct trauma. Symptoms include localized pain, swelling, and bruising on the inner ankle, along with a feeling of instability or difficulty bearing weight.
Stress fractures, tiny cracks in the bone, can occur in the medial malleolus, the bony prominence on the inside of the ankle. These usually result from repetitive stress and overuse, with pain gradually worsening during weight-bearing activities like running or jumping. The pain may also be present at night or upon direct touch to the affected bone. An avulsion fracture is another bone injury where a small piece of bone is pulled away by a tendon or ligament. These typically result from sudden, forceful movements, causing immediate and sharp pain, swelling, and bruising, similar to an ankle sprain.
Arthritis can also affect the ankle joint, leading to pain, stiffness, and swelling on the inside. Both osteoarthritis, which involves the breakdown of cartilage, and inflammatory types of arthritis, such as gout, can cause discomfort in this area. The pain associated with arthritis may worsen with activity and can be accompanied by reduced ankle mobility.
Nerve Compression
Tarsal tunnel syndrome occurs when the posterior tibial nerve, which runs along the inside of the ankle, becomes compressed or irritated. This nerve passes through a narrow space called the tarsal tunnel, located next to the ankle bones, and provides sensation and movement to parts of the foot.
Compression of the posterior tibial nerve can result from various factors, including swelling from an ankle injury, flat feet, or the presence of abnormal growths like cysts or bone spurs within the tunnel. Individuals with tarsal tunnel syndrome often experience characteristic symptoms such as pain, numbness, tingling, or burning sensations along the inside of the ankle and sometimes radiating into the bottom of the foot or toes. These symptoms may intensify with prolonged standing, walking, or exercise.
When to Seek Medical Attention
While mild ankle pain can often be managed with rest and home care, certain signs indicate that medical evaluation is needed. It is advisable to consult a healthcare professional if the pain is severe or worsens significantly over time. Inability to bear weight on the affected ankle or difficulty walking is also a clear indicator to seek medical help.
Other concerning symptoms include substantial swelling or bruising around the ankle, or any visible deformity. If a popping or cracking sound was heard at the time of injury, especially when accompanied by pain, it warrants professional assessment. Additionally, persistent pain that does not improve with home remedies within a few days or weeks, or pain accompanied by numbness or tingling sensations, should be evaluated to ensure an accurate diagnosis and appropriate care.