Lower limb pain in runners: Feet, ankles and Achilles explained

Often, runners experience lower limb pain after exercising. The causes can be multiple, but the most common is due to the repetitive load placed on the feet and ankles during running. As well, small training errors, such as increasing intensity too quickly, poor form, or insufficient rest cause chronic pain. It is very important to identify the exact cause rather than “running through it”. In this article you will understand why runners experience lower limb pain in feet, ankles, and achilles. Doctify offers experienced sports injury and orthopaedic specialists that can help in the diagnosis and management.

What causes heel pain in runners, and is it always plantar fasciitis?

Heel pain in runners is frequently occasioned by overload in the plantar fascia caused by tight calves, worn-out shoes, or increased weight training. The typical features of plantar fasciitis are micro-tears and pain with first steps in the morning. While the most common cause of heel pain in runners is plantar fasciitis, there are other causes of heel pain that can mimic plantar fasciitis like Achilles tendinitis, stress fracture, or nerve entrapment.

How do you recognise Achilles tendon problems?

An Achilles tendon lesion is the damage of the tissue connecting the calf muscles (gastrocnemius and soleus) to the heel bone (calcaneus). This tendon is fundamental in walking, running, and jumping, so the symptoms that might help you recognize it are:

• Pain and stiffness at the back of the heel
• Morning tightness that improves with movement
• Swelling or thickening along the tendon
• Difficulty to walk, run, or jump.

Achilles pain suggests overload (tendinopathy) when the pain is chronic, builds gradually, and improves with movement. Meanwhile, the achilles pain indicates a partial tear when the pain is sudden, severe, accompanied with swelling and inability to stand on tiptoes.

What does ankle pain during or after running usually indicate?

Ankle pain during or after running can be indicative of many things. Nevertheless, the most frequent are tendon irritation around the ankle and instability following previous sprains. In these situations, uneven surfaces and sudden increases in mileage play an important role in ankle pain because they act as major and compounding risk factors for musculoskeletal injuries.

Could it be a stress fracture rather than a soft tissue injury?

Stress fractures display differently from soft tissue injuries. Stress fractures are manifested with pain that does not ease with rest, localised tenderness on one specific point of bone, and gradually worsening pain that becomes more constant. Contrary to soft tissue injury, where predominates the presence of widespread pain, swelling, and tenderness. Stress fractures require early recognition because it is better to stop the progression in a minor, early-stage instead than in complete, full-thickeness bone fracture, which will require long-term immobilization or surgery.

When should imaging be considered?

Imaging is a great diagnostic aid for specialists and you should consider it when:

• Persistent pain despite reduced training
• Suspicion of stress fracture or significant tendon injury
• Severe swelling or inability to weight-bear

The images that are often used for the diagnosis are X-ray and MRI. But in this case, the MRI is always preferred over the X-ray because the MRI uses magnets for detailed imaging of soft tissues like muscles and ligaments, whereas X-ray are primarily used for detecting bone fractures and joint dislocations.

What are the red flags that need urgent medical review?

It is very important to get checked with your medical specialist, yet if you experience any of these red flags please look for urgent medical review:

• Sudden severe pain with a “snap” sensation
• Rapid swelling or deformity
• Inability to walk
• Signs of nerve involvement such as numbness or weakness

When should a runner see a specialist?

If you feel any of the following symptoms, please seek for assistance with a sports injury or orthopaedic specialist:

• Pain lasting more than a few weeks
• Recurrent injuries affecting training consistency
• Symptoms limiting performance or daily activities

Oftentimes, runners feel lower limb pain during or after exercising, it could be caused by plantar fasciitis, Achilles tendon problems, stress fracture, soft tissue injury, among others. In any of these cases, runners should be aware of the red flags and considerations for when images should be used. Doctify helps runners find experienced sports injury and orthopaedic specialists, read verified reviews, and arrange timely assessment and imaging when needed.

Feel free to consult an orthopaedic surgeon through Doctify for personalised advice, we will be happy to help you! Find the best orthopaedic surgeons in the United Kingdom or search for the best specialists globally:

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Medically Reviewed
Last reviewed on 03/03/2026