Foot and ankle pain

How common it is

A sprained ankle happens when you roll the ankle and overstretch or tear one or more of its ligaments. It is a common injury, especially among athletes, and having sprained the ankle before makes another sprain more likely. ^[1]

Heel pain is the other common story. The main symptom of plantar fasciitis is pain under the heel, often worse with the first steps in the morning or after long periods of standing or sitting. ^[2] Many people come to us with one of these, often some months after it started.

What can be behind it

The plantar fascia is a strong, thick band of tissue running along the sole from the heel to the toes, helping to form the arch. ^[2] It is more likely to become sore with a sudden increase in running or jumping, a lot of time on your feet, poorly supportive shoes, carrying extra weight, or tight or weak calf muscles. ^[2]

Ankle sprains most commonly happen when the foot points down and twists inwards. ^[1] In my clinical experience, an ankle that has been sprained often leaves stiffness in the ankle and the small joints of the foot, and a change in how the leg above it is loaded. The nerves to the foot also leave the spine in the lower back, so numbness or tingling in the foot can start there.

• Ligament strain after a rolled ankle
• Irritation of the plantar fascia under the heel
• Stiffness in the ankle and the small joints of the foot
• Referral or altered loading from the lower back, hip or knee

How we assess it

First we look for what should not be managed here. After an injury, an X-ray may be needed to rule out broken bones, and an ankle you cannot put weight on, or one that looks deformed, should be seen by a doctor. ^[1] A foot that is hot, red and swollen without an injury, or severe pain after a fall or a hard landing, is a referral to a doctor or the emergency department on the day.

Then the examination proper: movement of the ankle and the joints of the foot, the ligaments and the plantar fascia, calf flexibility, how you stand and walk, and a check of the knee, hip and lower back, including the nerve tests where there is numbness or tingling in the foot.

What care looks like

Care may include gentle adjustment of the ankle and the small joints of the foot where they are restricted, and of the lower back or pelvis where the examination implicates them. It comes with exercise every time: calf and plantar fascia stretches, balance work after a sprain, and gradually building load back up.

We would rather be plain about limits. Where footwear, orthotics or a structured rehabilitation program would serve you better, we say so and refer you to a podiatrist or another provider who is better placed.

When to seek urgent care

We are not an emergency service. If you have loss of bladder or bowel control, numbness in the saddle area, weakness in both legs, or pain after a serious accident, call 000 or go to an emergency department.