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Possible Stress Fracture in Your Ankle? Self-Checks, Red Flags, and What to Do Next

Hi, I started running two years ago, and since then have been running a bit over 2 miles 5-6 times a week. For the past few weeks, I've been tacking on a little more mileage (no more than 3/4 of a mile), but have been feeling some ankle pain on the inside of my ankle periodically.

Tonight I made the unwise decision of pushing myself to 4 miles, and while the rest of me felt great, the ankle pain persisted. When I got back home, I thought I was fine... sat down for a while to catch my breath... but when I got up again, the pain returned (it usually goes away after I stop running).

It doesn't hurt at all unless I rotate my ankle, and it hurts to walk.

As a ballet and pointe dancer of 17 years, I have very strong ankles, but I'm worried that I pushed myself to hard and may have a stress fracture. Any advice?

Thank you!

– Taya, St. Charles, MO

Answer by Dominique: Hi Taya,
Thanks for your question about your ankle pain after pushing up your mileage. As a ballet and pointe dancer of 17 years you clearly have strong ankles, but let's make sure.

Stress-fracture-pattern ankle pain is usually focal — one sharp spot you can point to — and it lingers after you stop running, wakes you at night, or gets worse when you bear weight. A sprain, strain or tendinitis tends to spread more broadly and settle down quickly once you're off your feet.

If any of the focal, persistent or weight-bearing signs are there for you, skip the "wait a few days and see" approach below — go straight to the red flags section.

I'll break my response down as follows:

1. My Original Answer: Rest, Ice and a Two-to-Three-Day Wait
2. Self-Checks: Is This Pain Focal or Diffuse, and Does It Change With Weight-Bearing?
3. Red Flags: When a 2–3 Day Wait Isn't the Right Call
4. If Your Doctor Wants Imaging: What to Expect

1. My Original Answer: Rest, Ice and a Two-to-Three-Day Wait

Ankle pain can be caused by a number of things. Most common ankle injuries are a sprained ankle, strained ankle a stress fracture, or tendinitis.

It is impossible to diagnose you from here and to know whether it is ligaments, tendon and/or bone that are giving you the pain.

You may have pushed yourself too hard, but you have got a pretty solid base with your dancing and running 5-6 times / week. You may find that it is just some initial push back from your body to the additional mileage.

For now, however, it is definitely best to take it easy and to make sure you do not further aggravate your ankle. Ice, rest and anti-inflammatory medicines can all help. Over the next few days you will find out if your ankle heals and all will return to normal, or that there is indeed a bigger issue.

I suggest that you do not run for the next two or three days and ice it. If after that your ankle is still sore, go see your doctor to find out what is the problem.

Your pain sat on the inside of your ankle, came on with rotation, and returned once you'd stopped running rather than easing off straight away. It's worth checking that pattern against the red flags below — pain on rotation isn't itself a red flag, but pain that persists after you stop is one of the signs that's changed what I'd tell you today. I haven't rewritten my original answer above; the red flags section below is where the guidance has actually moved on.

2. Self-Checks: Is This Pain Focal or Diffuse, and Does It Change With Weight-Bearing?

Two quick checks can help you work out which pattern you're dealing with, before you decide what to do next.

Press a fingertip firmly around the inside and front of your ankle. That's the palpation check. A single sharp, reproducible point of pain — often right over the bony bump on the inside of your ankle, or the navicular bone on top of your foot — suggests a stress reaction. A broad area that's tender wherever you press is more consistent with a sprain or strain.

Then try the weight-bearing check. Stand on the leg. Walk on it. Hop gently on it. Pain that shows up or worsens specifically when you bear weight — not just during the run itself — is a stronger stress-fracture signal than pain that's purely activity-dependent.

Beware — these are screening checks, not a diagnosis. They shift the odds one way or the other; they don't settle anything on their own. I use the same kind of self-check for shin pain, and the logic holds here too.

3. Red Flags: When a 2–3 Day Wait Isn't the Right Call

A short trial of rest and ice before you see anyone can be a sensible starting point — but only when none of the following apply to you. If any of these are true, see a doctor now rather than waiting out the two or three days:

• Focal, pinpoint tenderness at one specific spot, rather than a broad tender area
• Pain that persists at rest or wakes you at night
• Pain that worsens or shows up specifically with weight-bearing — standing, walking or hopping — not just during the run
• Visible swelling directly over the bone
• No improvement at all after a day or two off running

I want to be direct about this, because it's a genuine update on what I'd have told you a few years back. That 2–3 day wait-and-see trial is a reasonable starting point for mild, diffuse, load-only pain. It is not the right advice once any focal, rest or night-pain sign shows up. Those cases need evaluation now, not a few more days of monitoring.

This is the boundary between what I can help you with as a coach and what needs a clinician's assessment. I've spent over 20 years at Best Running Tips, and the red flags above are informational — they're not a diagnosis of your ankle. For the full picture across every running injury, see the full red-flag escalation guide for running injuries.

4. If Your Doctor Wants Imaging: What to Expect

If your doctor does want imaging, here's what actually happens next. A first X-ray can come back completely normal in an early stress fracture — that's common, not a sign anything went wrong with the test. If your exam and history still point that way, your clinician may recommend a magnetic resonance imaging (MRI) or a bone scan regardless of a clear X-ray.

I've covered what imaging clearance actually involves in full elsewhere, rather than repeating it here — and once you're cleared, the full return-to-running protocol once you're cleared picks up from there.
Most ankle pain after a mileage push turns out to be simple pushback from added training load — but not always, and the point of this page is helping you tell the difference before you decide whether to run tomorrow.

Do the self-checks, be honest with yourself about the red flags, and don't let a stubborn "it's probably fine" talk you out of a five-minute doctor's visit.

All the best,
Dominique :)

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