If your ankle has been aching for weeks and you can’t quite figure out why, the location of the pain is the first clue. Several tendons run around your ankle, and each one creates a slightly different problem when it gets irritated. Inner ankle, outer ankle, front, back, they all point to different culprits and need different approaches to settle down properly.
The treatment for inner ankle tendonitis isn’t the same as outer ankle tendonitis. Getting the right diagnosis from the start means you stop wasting time on the wrong fixes and you avoid the frustrating cycle most people end up with.
What Is Tendonitis?
Tendons are the thick cords that connect your muscles to your bones. Tendonitis, also called tendinitis, is caused when one of those tendons gets irritated, inflamed, or worn down. It is called Tendinopathy when the tissue has actually started to change structurally, but they all refer to the same kind of problem. The ones around your ankle and lower leg cop a lot of this because they absorb load every single step you take.
Most ankle tendonitis doesn’t come from one obvious incident. It builds up. You might notice a dull ache during or after an activity that goes away with rest. You might feel stiff in the morning, which loosens up after a few minutes of walking. Maybe there’s a tender spot along the tendon when you press on it. If you’ve been ignoring it for a while, the pain can become a constant companion, showing up even when you’re sitting still.
The four tendons most likely to be the source of your problem are the tibialis posterior (inside of your ankle), the peroneals (outside), the tibialis anterior (front), and the Achilles (back). Working out which one is the troublemaker changes everything about how you treat it.
Inner Ankle Pain – Tibialis Posterior Tendinopathy
If the pain is on the inside of your ankle, especially around the bony lump on the inner side or running down into your arch, the tibialis posterior tendon is usually the one to look at. This tendon starts deep in your calf, wraps behind that inner ankle bone, and spreads out to attach to several spots on your foot. Its main job is holding up your arch and controlling how your foot rolls inward when you walk.
When it gets overloaded, it gets sore. You’ll feel it along the inside of the ankle, sometimes spreading down into the arch or around the inner heel. Walking and standing make it worse. Rest helps at first, but once it’s been going for a while, the discomfort tends to hang around even when you’re off your feet.
This one shows up most in people with flatter arches, in anyone who’s ramped up their training quickly, and in active middle-aged adults. It’s worth taking seriously because if you leave it alone, the tendon slowly loses its ability to hold your arch up, and your foot can gradually flatten over time. Treatment usually centres on Orthotic Therapy to take the load off the tendon, along with calf and foot strengthening. For the stubborn cases that aren’t budging, Shockwave Therapy can make a real difference.
Outer Ankle Pain – Peroneal Tendonitis
The peroneal tendons run behind the outer ankle bone and down into the outside of your foot. Pain along the outside of your ankle (sometimes spreading into the outer edge of the foot) usually means these tendons are involved. It tends to flare up with activity, especially running on uneven ground, sudden cutting movements, or anything that loads the ankle sideways.
You see this a lot in runners and in anyone who’s had ankle sprains in the past. The peroneals are what stabilise the outer ankle, so when the ankle has lost some of its stability from previous injuries, these tendons end up doing more work than they’re built for. High arches and rolling outward when you walk can also pile on the load over time.
Settling it down usually means changing your activity in the short term, strengthening the peroneal muscles and the rest of the ankle stabilisers, looking at your footwear, and addressing whatever biomechanical issue is contributing. Achilles tendon taping and ankle stabilisation strapping can take some heat off the area while you work on the underlying cause.
Front of the Ankle – Tibialis Anterior Tendinopathy
Pain across the front of your ankle or the top of your foot, particularly when walking downhill, going down stairs, or on uneven ground, can mean the tibialis anterior tendon is the issue. This tendon runs down the front of your shin, crosses the front of the ankle, and attaches to the inside of your foot. It’s the muscle that lifts your foot with every step, which is why it grumbles most during activities that involve lifting the foot repeatedly.
This one’s less common than the inner and outer ankle versions, but it does happen. Hikers, cyclists, and skiers see it. So does anyone whose shoes put pressure across the top of the foot or who laces their shoes too tightly across that spot. The approach is the same as the others: reduce the load for a bit, sort out the footwear, build the strength back up gradually, and figure out what’s actually causing it.
Back of the Heel – Achilles Tendinopathy
The Achilles is the biggest tendon in your body connecting your calf muscles to your heel bone. If the first few steps out of bed in the morning feel stiff and sore at the back of your heel, and it loosens up as you get moving, that’s the classic Achilles tendinopathy pattern.
It’s the runner’s tendon, especially for anyone who’s recently pushed their training harder or further. But it also shows up in people who spend a lot of time in flat shoes, or who have tight calves. Spring ligament exercises and surrounding lower limb work feed into this because everything in that area shares the load. Calf strength and flexibility are at the centre of any good recovery program.
Why Rest Alone Usually Doesn’t Fix It
Tendons don’t heal the way muscles do. A muscle injury responds well to rest, the tissue knits back together, and you’re good to go. A tendon that gets completely unloaded actually loses some of its strength. You need to keep loading it, just at a level it can handle, and then build that load back up gradually.
This is why the rest-then-return approach keeps failing for so many people. The tendon settles down, you go back to normal activity, and the load jumps from almost nothing back to your usual training in one go. That’s exactly the kind of spike that caused the problem in the first place, so the pain comes straight back.
A proper plan with specific exercises, gradual load progression, and attention to whatever caused the issue in the first place gives you a much better outcome than just resting and hoping for the best. A podiatrist or sports podiatrist can put together a personalised plan that takes your specific tendon, your activity level, and how long you’ve been dealing with it into account.
Treatment Process
The treatment starts with a proper assessment. Different tendons get loaded by different movements and influenced by different things, so the treatment needs to match the tendon and the reason it became overloaded.
A biomechanical assessment looks at how your foot and lower limb actually move when you’re loaded up, how your arch works, how your foot strikes the ground, your strength and flexibility, and anything in your walking or running pattern that’s adding to the problem.
That tells us whether the main treatment should be orthotic therapy, a specific exercise program, footwear changes, activity changes, or some combination of all of them. Sports podiatry takes it a step further by factoring in what your sport demands and helping you keep your conditioning while you recover.
When To Stop Managing It Yourself
Most ankle tendon problems start mild and seem manageable with a bit of rest. The trap is the improvement-and-relapse cycle. A few days off and it feels fine. Back to normal activity, and the pain comes back. Each round of this tends to take a little longer to settle, and after a few cycles, the tendon can get deeper into trouble and take much longer to recover.
If you’re based in Adelaide and your ankle has been sore for more than two weeks, keeps coming back after rest, or is starting to get in the way of your normal activity, it’s time to get it properly assessed.
Our team at AC Podiatry assesses and treats all types of ankle tendonitis, from early irritation to longstanding cases, with tailored treatment plans that get to the root of what caused the problem in the first place.
To arrange an appointment, you can call (08) 8255 5575 or book online at a time that suits you. We have podiatry clinics in Oakden, Adelaide CBD, Magill, and Malvern.
