Ankle and knee pain from running, particularly pain that’s noticeably worse when running downhill, is a presentation we see regularly, and it’s rarely just about the running itself. More often, it’s related to how your foot and shin are aligned and how your body compensates for that alignment with every stride.

 

Why Downhill Running Often Makes It Worse

Running downhill increases the load travelling through the ankle and forefoot, and can expose underlying alignment issues that feel manageable on flat ground. One common contributing factor is internal tibial torsion, an inward twist of the shin bone that’s typically genetic. Where this is present, the body often compensates through the hips, tightening the gluteal muscles and the IT band while the muscles at the front of the thigh weaken. This compensation can mask the underlying rotation, which is part of why it’s often missed.

 

What We Look At

A biomechanical assessment looks at hip rotation range, tibial torsion, and how much your feet pronate under load, since these all interact with each other during running. We also consider forefoot alignment a forefoot valgus, for example, is a classic contributing factor to lateral ankle sprains, particularly when running downhill.

 

Our Approach

Running places roughly 4–5 times body weight through the feet with every stride, which is significantly more than walking. Because of this, running orthotics are generally different in material and design from everyday orthotics, and many runners benefit from having a separate pair for training versus daily use.

 

Treatment Options We Offer

  • Custom orthotics including running-specific devices where appropriate
  • Targeted strengthening, particularly for the front of the thigh (VMO)
  • Stretching for the gluteals and IT band
  • Foot mobilisation including addressing cuboid syndrome, which can occur with recurring lateral ankle sprains
  • Dry needling or deep tissue massage used to help address scar tissue in overworked muscles, such as the outer shin.

 

Frequently Asked Questions

Do I need different orthotics for running versus everyday use?

Often, yes, the forces involved in running are considerably higher than walking, and running-specific orthotics are generally built with different materials and angles to account for this.

Can tibial torsion really affect how I run?

Yes, it can influence how your hips, knees and feet align through each stride, and downhill running in particular can make any underlying rotation more noticeable.

 

Book an Assessment

If you’re managing recurring pain from running, book a biomechanical assessment at your nearest Dr Abbie Clinics location.

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