Inside Ankle Pain: Causes, Symptoms, and Effective Treatments

Anatomy of the Inside Ankle

The deltoid ligament (medial ankle ligament) is the main stabilizer of the inside (medial) ankle. Inside ankle pain refers to discomfort on the medial side of the ankle joint, often due to stretching or injury of the deltoid ligament, especially during excessive dorsiflexion and eversion.¹

The posterior tibial tendon, running behind the shin bone and near the Achilles tendon, supports the arch of the foot and stabilizes the ankle during walking. Injury or inflammation of this tendon can also cause inside ankle pain.

Inside ankle pain can range from mild sprains to severe ligament tears. While less common than lateral ankle pain, medial ankle injuries often take longer to heal and are frequently seen in trail runners, basketball players, and water skiers.

How Is Inside Ankle Pain Graded?

1. Grade I: Microscopic stretching/disruption of the deltoid ligament. Medial stability is mildly compromised.
2. Grade II: Partial tearing and stretching of the deltoid ligament, seen on MRI. Stability is further reduced.
3. Grade III: Complete rupture of the deltoid ligament, causing significant instability and severe pain.

Common Causes of Inside Ankle Pain

1. Medial Malleolar Stress Fractures

Stress fractures of the medial malleolus (the bony knob on the inside of the ankle) cause pain, especially during jumping or running, and improve with rest.² Swelling and tenderness are common. For more, see medial malleolus pain causes.

2. Inside Ankle Sprain (Eversion Sprain)

Eversion sprains occur when the foot rolls outward, stretching or tearing the deltoid ligament. Symptoms include pain, swelling, and instability.³

3. Posterior Tibial Tendonitis

Inflammation or overuse of the posterior tibial tendon causes pain behind the medial malleolus and sometimes under the foot. If untreated, it can lead to adult-acquired flatfoot deformity.

4. Ankle Arthritis

Osteoarthritis, rheumatoid arthritis, or post-traumatic arthritis can cause chronic inside ankle pain.⁴

5. Tarsal Tunnel Syndrome

Compression of the tibial nerve in the tarsal tunnel leads to pain, tingling, or numbness on the inside of the ankle. Symptoms can mimic plantar fasciitis.

Symptoms of Inside Ankle Pain

• Pain on the medial (inside) ankle, especially with movement
• Stiffness and swelling of the ankle joint
• Clicking or crepitus with movement
• Tenderness and bruising on the inside of the ankle
• Instability or weakness when walking⁵

How Is Inside Ankle Pain Diagnosed?

1. Eversion Stress Test

This test checks the stability of the medial ankle and integrity of the deltoid ligament. The tibia is stabilized while the heel is abducted and everted. Pain and laxity indicate a positive test.⁶

2. Imaging

X-rays detect fractures or ligament detachment. MRI scans provide detailed images of soft tissue injuries and ligament tears.

Treatment Options for Inside Ankle Pain

Treatment depends on the cause and severity. Acute pain is often managed with the RICE protocol, while chronic or severe cases may require advanced therapies.

Prolotherapy

In recent years, Prolotherapy has built its reputation within the medical community for its clinically proven ability to treat inside ankle pain.
Published research has proven its pain-relieving, anti-inflammatory and regenerative benefits.
Prolotherapy involves injecting a natural regenerative solution with tiny needles. This has been shown to stimulate the production of collagen cells, the small cells needed to help with inside ankle pain.
As prolotherapy is helping to treat the root cause of inside ankle pain, it is deemed to be a permanent fix, preventing the symptoms from returning.

1. RICE

Rest, Ice, Compression, and Elevation reduce inflammation and pain in the acute stage.

2. Physical Therapy

Rehab exercises retrain the deltoid ligament, improve strength, range of motion, proprioception, and balance.⁷

3. Medication

NSAIDs and topical anti-inflammatories help reduce pain and swelling. Opioids may be prescribed for severe fractures.

Non-invasive options include braces, custom orthotics, steroid injections, and splints.

4. Surgery

Surgery may be needed for recurrent sprains or severe instability. An orthopedic surgeon can repair and reconstruct the ankle bones and ligaments.

How Can Inside Ankle Pain Be Prevented?

• Maintain a healthy weight
• Stop or slow activity if pain develops
• Wear supportive footwear, insoles, or orthotics
• Warm up before activity
• Avoid resisted inversion of the foot
• Use ankle braces if needed

The Bottom Line

Inside ankle pain is often a dull, throbbing discomfort caused by injury, wear and tear, or instability of the medial ankle. Early intervention with rest, physical therapy, and biomechanical correction can help. Immobilization and avoiding weight-bearing activities are crucial during recovery.

Frequently Asked Questions

Why is my ankle hurting on the inside?

Causes include arthritis, injury, or wear and tear. Symptoms may include stiffness, swelling, or pain. Rest, ice, and OTC medications can help.

What can cause inside ankle pain without injury?

Bursitis, osteoarthritis, scleroderma, lupus, flat feet, reactive arthritis, gout, and rheumatoid arthritis.

What exercise is good for ankle pain?

Elevate your foot and perform gentle rotations. Repeat 20 times per leg. Avoid high-impact activities until pain subsides.

What are the signs of gout in the ankle?

Redness, tenderness, limited movement, stiffness, warmth, and swelling.

Is it ok to walk with posterior tibial tendonitis?

Initial treatment is rest. Most people can walk normally after 3 months, but full recovery may take up to a year.

Which is the fastest way to heal posterior tibial tendonitis?

Apply cold packs for 20 minutes, 3–4 times daily. Avoid direct ice contact with skin. Ice after exercise to reduce inflammation.

Contact ProHealth Clinic Today for Your FREE 15-Minute Discovery Call

Don’t let inside ankle pain control your life any longer. Join the thousands of patients who have found lasting relief through prolotherapy at ProHealth Clinic.

Get in Touch

• Phone: +44 1234 380345
• Email: info@prohealthclinic.co.uk

Our Clinic Locations

• London: 104 Harley Street, Marylebone, W1G 7JD
• Manchester: The Hadley Clinic, 64 Bridge Street, M3 3BN
• Bedford: The Village Medical Centre, Kingswood Way, MK40 4GH

All clinics offer the same award-winning prolotherapy treatment with convenient appointment times, including evenings and weekends.

Author Bio

Having performed over 10,000 procedures, Mr Eaton is one of the UK’s leading practitioners in the field of treating inside ankle pain, with patients travelling to see him from across the UK, Europe, and the Middle East.
With over 12 years of clinical experience, Oliver is dedicated to helping patients understand their symptoms associated with inside ankle pain and providing effective treatment options to alleviate them.
He qualified in Prolozone Therapy and Prolotherapy in America with the American Academy of Ozonotherapy. He continued on to complete further qualifications at the Royal Society of Medicine, Charing Cross Hospital in London, Keele University’s Anatomy & Surgical Training Centre, and the medical department of Heidelberg University in Germany.
Over the years he has had the privilege of treating many elite-level athletes, including both Olympic and Commonwealth medallists.
LinkedIn profile

References

1. Crim J. Medial-sided Ankle Pain: Deltoid Ligament and Beyond. Magn Reson Imaging Clin N Am 2017;25:63–77. https://doi.org/10.1016/j.mric.2016.08.003
2. Carter TH, Duckworth AD, White TO. Medial malleolar fractures. Bone Joint J 2019;101-B:512–21. https://doi.org/10.1302/0301-620x.101B5.BJJ-2019-0070
3. Waterman CPTBR, Philip LTC, Jr JB, Cameron KL, Svoboda LTCSJ, Alitz COLCJ, et al. Risk Factors for Syndesmotic and Medial Ankle Sprain Role of Sex, Sport, and Level of Competition 2009:992–8. https://doi.org/10.1177/0363546510391462
4. Arthritis of the Foot and Ankle – OrthoInfo – AAOS. https://orthoinfo.aaos.org/en/diseases–conditions/arthritis-of-the-foot-and-ankle/
5. Ruiz R, Hintermann B. Clinical Appearance of Medial Ankle Instability. Foot Ankle Clin 2021;26:291–304. https://doi.org/10.1016/j.fcl.2021.03.004
6. de Vries JS, Kerkhoffs GMMJ, Blankevoort L, van Dijk CN. Clinical evaluation of a dynamic test for lateral ankle ligament laxity. Knee Surg Sports Traumatol Arthrosc 2010;18:628–33. https://doi.org/10.1007/s00167-009-0978-7
7. Mattacola CG, Dwyer MK. Rehabilitation of the Ankle After Acute Sprain or Chronic Instability. J Athl Train 2002;37:413–29. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC164373/
8. Bubra PS, Keighley G, Rateesh S, Carmody D. Posterior tibial tendon dysfunction: an overlooked cause of foot deformity. J Family Med Prim Care. 2015;4(1):26–29. https://doi.org/10.4103/2249-4863.152245