Outer Ankle Pain When Running- Causes, Treatment, and Prevention
- Jordan Metcalf
- Feb 15
- 8 min read
Let me guess: You Googled 'outer ankle pain running' and found a bunch of generic articles that left you more confused than when you started. If that's you, welcome! As a physical therapist who specializes in running injuries, I'm going to give you WAY more detail about outer ankle pain when running, its potential causes, and how to approach treatment. In this post, you’ll understand what’s causing your outer ankle pain, when to see a medical professional, and what you can do about it.
What Does "Outer Ankle Pain" Actually Mean?
For our purposes, let’s define outer (lateral) ankle pain as anything within the red oval pictured below. Pain in different regions of that oval can indicate different injuries.
Outer Ankle Pain When Running: Causes & Treatment
Peroneal tendinopathy
The peroneal muscles run down the outside of your lower leg, behind your ankle bone, and attach to your foot. They make the foot go “down and out” (plantar flexion and eversion) and help you push off over the big toe when you run.
Peroneal tendinopathy is injury and weakening of the peroneal tendon. This injury often develops while recovering from an acute injury like an ankle sprain. It can also develop by running with altered gait mechanics, on a slanted surface, or with improper footwear.
Fibular Stress Fracture
Fibular stress fractures are not the most common stress fracture location for runners, but they certainly do happen. Stress fractures or bone stress injuries (BSIs) typically hurt worse with weightbearing, do not warm up, and correspond to a recent increase in training volume or intensity. They also often cause the injured bone to be tender to the touch.
However, fibular stress fractures can often get missed because symptoms are assumed to be muscle or tendon related. Seeing a medical professional and getting imaging are the best ways to confidently diagnose this injury. (1)
Ankle Sprain
Ankle sprains are another less common running injury because of the nature of the sport. Ankle sprains are typically acute (meaning they happen all at once vs. due to repetitive stress) and happen with sudden changes in direction or changes in terrain.
Trail runners or running on uneven or snowy terrain may increase the risk of ankle sprains. Typically, a runner would be able to point to the exact moment or at least the exact workout where their pain started, and there is often some swelling and/or mild bruising with an ankle sprain.
In my professional experience, I have found more runners sustain repetitive stress injuries because of prior ankle sprains that left them with lingering mobility or strength deficits. My OWN previous ankle sprain most certainly contributed to a bone stress injury that I sustained in my foot.
Base of the 5th Metatarsal Stress Fracture
While this injury technically happens in the outer foot, it is worth mentioning because it is an injury that occurs more in running than other sporting populations and benefits greatly from early detection. This injury, also called a Jones fracture, is considered a high risk bone stress injury because of its impaired healing potential.
The symptoms of this injury are often quite clear: pain and difficulty walking, and tenderness at the base of the 5th metatarsal. If those symptoms are present along with a recent spike in training volume or intensity, it’s important to see a medical professional right away.
The base of the 5th metatarsal (foot bone) doesn’t get great blood supply. As a general rule, if it doesn’t have good blood supply, its healing potential is less. For this reason, this injury is often treated with surgical fixation of the bone.
How to Know What's Causing YOUR Outer Ankle Pain
Now that you know some of the common causes of outer ankle pain when running, here are some questions that you can ask yourself to help you decide how to proceed:
Where does it hurt?
Look at the diagrams above. If your pain lands in one of the bone stress injury locations, you need to stop running until you see a medical professional.
Does my pain warm up?
Pain that improves as you run is typically tendon or muscle-related—good news, because these tissues respond well to targeted rehab without stopping running completely. Injuries to bone are less likely to warm up throughout a run, therefore this pain behavior is more concerning and should be evaluated by a medical professional.
Do I have pain with prolonged standing or walking?
Pain with prolonged weight bearing or walking should be evaluated by a medical professional before continuing to run. These are common symptoms that present with bony injuries, which often require a period of off-loading using a boot or crutches before starting to run again. These symptoms don’t always indicate a bone stress injury, but you should let a medical professional make that call.
If you answer yes to two out of these three questions, then you should see a medical professional to rule out a bony injury:
Location– is my pain in a location where bone stress injuries often occur?
Behavior– does my pain stay the same or get worse as I run?
Weight-Bearing– does my pain get worse with prolonged walking or weight-bearing?
Treatment of Outer Ankle Pain
Immediate steps (what to do this week)
If your symptoms indicate that you might have a bone stress injury, then you need to stop running and see a medical professional.
If not, then starting with some recovery strategies like wearing compression socks, self massage or foam rolling, and making sure to get enough sleep are all good initial strategies.
The exercises that you use to address your outer ankle pain should be specific to your injury. There isn’t just one list of exercises that fix ALL outer ankle pain, though that would make my job easier! With that said, I’ve included some of my favorite general ankle strengthening exercises in the prevention section that you can do to keep your ankles strong and resilient.
When and how to modify your training
If you are cleared to continue training, then initially modifying your training load and running surfaces can help prevent your outer ankle pain from getting worse.
For tendon and muscle injuries, your pain should return to baseline within 24 hours of running. If your pain is increasing or not settling down the next day, your training load is too high. Decrease your mileage, back off intensity, or try a walk-jog progression.
Outer ankle pain will likely respond best to running on flat surfaces. You may be especially sensitive to running on a cambered surface, for example, a road that is higher in the middle than it is by the curbs. This causes increased strain on the outside of one ankle and the inside of the other. This also may be a good time to consider using different footwear or ankle supports to allow you to continue training without overloading your ankle tissues.
If running is just not tolerated well, then doing low impact cardio (bike, elliptical) are good substitutions to maintain your cardiovascular base while your ankle is healing.
Prevention: Keeping Outer Ankle Pain From Coming Back
Ankle stability work
Shoe rotation/selection tips
There is not one particular shoe that is perfect for preventing outer ankle pain. The general recommendation for whatever shoe you run in is that it should feel comfortable to you. I know…captain obvious.
With that said, here are some of the features that I encourage my runners to think about:
Heel to toe drop (also known as offset): In most running shoes, the heel is anywhere between 4 and 12 mm above the toe putting the runner in a tiny bit of a heel. While a millimeter here and there might not make a huge difference, typically running in a lower drop shoe puts more strain on the achilles tendon, and a higher drop shoe puts more strain on the knees and big toe joints. There isn’t a “right” or “wrong” amount of drop, but running in a low drop shoe when you have foot or ankle pain might be less comfortable or even cause pain.
Stack Height: This is how high the shoes are off the ground. Recent running shoe trends seem to be pushing stack heights higher and higher, likely because of the supposed increase in running efficiency with the addition of certain types of foam. (2) Runners with less foot and ankle stability may prefer shoes with a lower stack height, but it’s still pretty subjective.
Neutral vs. stability: This has to do with how much rigid support the shoe provides. Neutral shoes are usually more malleable, allowing your foot to move in your natural pattern, whereas stability shoes have more rigid supports that nudge your foot into a supposedly more stable position. My approach is to encourage runners to run in the most neutral shoe that they can tolerate to allow their foot to change shape naturally while running, but for certain foot types, stability shoes can be helpful.
Training error red flags
Overuse injuries happen when training load increases too quickly or recovery is inadequate.
Many runners that I see at Alterra sustain injuries when they take their easy runs too fast, when they don’t adjust their training after getting a few bad nights of sleep, or they try to train through illness.
Research is mixed on which training parameters have the biggest impact on your injury risk, but it seems as though some recent studies have found that the rate of increase of your longest long run over the last 30 days matters more than the change in your weekly mileage. (3)
When to Seek Help
Outer ankle pain that is gradually getting worse, fits the criteria for a bone stress injury, or is limiting you from being able to stick to your training plan should be evaluated by a medical professional. For injuries to bone, the “healing clock” starts once you start offloading. That means that if you continue training through pain, it will take you longer to recover. If you’re training for a race, you don’t have weeks to chase your tail thinking your pain is just a cranky tendon.
At Alterra, we treat running related injuries every day! Running and helping runners is our passion, and we are experts in the injuries that are common to the sport. We start our injured runners off with a thorough evaluation to get a full picture of their running ecosystem to zero in on what’s causing their specific injury, and how we can help them get back to performing their best.
Conclusion
Outer ankle pain when running is a very treatable problem. Whether you’re dealing with a cranky peroneal tendon, or a brewing bone stress injury, getting an accurate diagnosis quickly is super important to ensuring a quick recovery.
At Alterra, we specialize in running injuries, so if you’re a runner in Boston dealing with outer ankle pain, we’d love to help! Book a free discovery call to talk to a therapist today.
Disclaimer: The information in our blog posts is not a substitute for professional medical advice. Consult a healthcare provider before making decisions related to your health. Use our content at your own risk.
Sources
Bone Stress Injuries in Runners: Tenforde, Adam S. et al. Physical Medicine and Rehabilitation Clinics, Volume 27, Issue 1, 139 - 149.
Hoogkamer, W., Kipp, S., Frank, J.H. et al. A Comparison of the Energetic Cost of Running in Marathon Racing Shoes. Sports Med 48, 1009–1019 (2018). https://doi.org/10.1007/s40279-017-0811-2
Schuster Brandt Frandsen J, Hulme A, Parner ET, et alHow much running is too much? Identifying high-risk running sessions in a 5200-person cohort studyBritish Journal of Sports Medicine 2025;59:1203-1210.
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