Anterior Ankle Tendinopathy: Pain at the Front of the Ankle in Runners

What is anterior ankle tendinopathy?

The anterior ankle houses several tendons - primarily tibialis anterior, extensor hallucis longus, and extensor digitorum longus - that run across the front of the joint to control foot lift and toe extension during running.

When overloaded, these tendons become painful and occasionally swollen along their course. Pain at the front of the ankle that worsens with running, particularly on hilly terrain or in stiff shoes, points to these tendons.

Common triggers

• Tight or stiff shoes with a low tongue that creates pressure directly over the tendons
• Downhill running - the foot dorsiflexes more aggressively and loads the tendons
• Sudden mileage increases
• Running on steep or uneven terrain

What helps

1. Shoe and lacing adjustment

Loosen the laces over the middle of the foot or use a lacing technique that bypasses the tender area. A shoe with a softer or thicker tongue reduces direct compression.

2. Isometric tibialis anterior contraction

Seated, pull the foot up (dorsiflex) and hold against resistance for 30 seconds. 4 sets. Reduces pain through sustained contraction.

3. Eccentric lowering

Stand on tiptoe, lower the foot slowly back to flat, then actively dorsiflex. 3 sets of 15. Progressive tendon loading.

4. Ankle mobility work

Knee-to-wall calf stretch - improves dorsiflexion range so the tendons are not at end-range repeatedly. 3 × 45 seconds each side.

5. Hip and glute strengthening

Reduces the load distributed to the lower leg and ankle during running.

Return to running

Most cases improve within 4–6 weeks. Ensure footwear is not creating direct compression over the tendons. Soft-surface running during recovery reduces load on the anterior ankle structures.