Ankle injuries have forever been the bane of runners, so what makes them so susceptible and what are the most common causes of ankle injuries in running?

Overuse and training errors

Sudden increases in mileage, intensity, or frequency don’t allow tissues enough time to adapt. This is a classic cause for issues like Achilles tendinopathy or general ankle pain. Examples of this include returning to running after injury or after a significant period off running. Even for seasoned runners, training modifications such as adding hill sprints or interval training too quickly can overload the ankle complex.

Poor running mechanics

Biomechanical predispositions such as overpronation (excess inward rolling) or supination (outward rolling) can strain ligaments/tendons and also change the mechanical load throughout the carpal bones during each step. Weak hip or core control can also cascade down to the ankle, increasing injury risk.

Inadequate strength and stability

The ankle relies on stabilizing muscles to help maintain positioning and load in running to avoid excessive inversions/eversion. Weakness in these muscles or poor balance makes sprains, particularly inversion sprains, more likely. These are among the most common acute injuries in runners, often classified as ankle sprain.

Uneven or unpredictable surfaces

Running on different terrains, such as trail, cambered roads, potholes, or loose gravel increase the chance of awkward foot placement and altered gait.

Footwear issues

Worn-out, poorly fitted, loose cushioning and ill-support footwear can increase the chance of ankle injuries. Shoes that don’t match your gait (too much or too little stability) can alter loading patterns and contribute to injury.

Limited mobility or flexibility

Restricted ankle dorsiflexion (ability to bring your knee forward over your foot) can shift mechanics and load, increasing strain on the ankle.

Fatigue

As muscles tire, coordination and posture deteriorate. Late in a run, you’re more likely to misstep or lose proper form, raising injury risk.

Previous injuries

Previous ankle injuries, such as sprains, can result in permanent soft tissue damage and instability and can increase the chance of reinjury up to 50%. However, this is significantly reduced with rehabilitation and therapy management.