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Foot and ankle

This page provides you with information and self-help advice for managing musculoskeletal foot and ankle problems.

Foot or ankle pain is a common complaint and can be caused by many different things. As we use our feet and ankles so much in everyday activities, it can be very worrying when it is painful to walk, run, or jump. 

Ankle and foot problems can cause a range of symptoms - including pain, swelling and stiffness. Most of the time, you do not need to see a healthcare professional immediately, as the majority of new issues or flare-ups often settle within 6 weeks. 

When to speak to a health professional

These symptoms are rare but you should contact a doctor if you experience any of them as there can be other causes for them:

  • Pain that is waking or keeping you up at night. Worse pain than during the day that prevents you from sleeping due to increasing pain and/or difficulty lying flat.
  • Pain for over three months, or pain that is progressive and not eased.
  • Unexplained swelling of your one or both feet or other joints too. 
  • Hot swollen and painful calf muscle.
  • You develop a hot and swollen joint for no apparent reason.
  • Changes in sensation in your feet.
  • Changes to the shape of your foot.
  • Loss of power e.g. unable to pick your foot up or frequent tripping.
  • A skin rash, skin discolouration, ulceration or signs of infection.
  • The pain you are experiencing is getting worse rather than better despite following the self-management guidance for your condition in the time frame expected.
  • Symptoms have not been significantly helped by a trial of medication as expected.
  • You feel unwell and suffer symptom such as fever, night sweats or weight loss.
  • You experience a change in your ability to walk including balance problems or weakness/heaviness in your legs.
  • Early morning stiffness, lasting for longer than 30 minutes.
  • New on-set severe headache.

Please visit this link for information on symptoms of Deep Vein Thrombosis (DVT) a serious condition relating to a blood clot, commonly occurring in the leg.

Self help and recovery

It is good to continue to use your foot or ankle as normally as possible but you might need to make some adjustments to what you do for a while. There are things that you can do to help yourself while your ankle or foot is painful.

  • Use some strapping or a support to help your foot initially. In some cases you may need to relieve the weight on your foot for a while. You can use a stick or crutches to do this.
  • Change how long you spend on your feet at one time, taking small rests as you need them.
  • Gradually build up your exercises and weight bearing activities, to help your return to full function.
  • Getting fitter and stronger can also help reduce your foot and ankle pain. These joints take our body weight during use. Because of this it is helpful for them if you are closer to your ideal weight.
  • You can also try taking pain relief medication and/or using ice or heat.

Poor fitting or unsupportive footwear can be one of the causes of foot pain.

Each foot is made up of 26 bones and over 33 small joints, which work with ligaments, muscles and tendons. These joins create a structure that can be both stable, yet also flexible and adaptive to its environment. As we age, the structure of the foot changes, especially in the arch of their foot. Arthritis may also affect joints of the foot.

The majority of musculoskeletal conditions get better within six to eight weeks although sometimes they can persist for longer, but this doesn’t mean there is something seriously wrong.

However, rarely, musculoskeletal symptoms can be caused by something more serious and it is important for you to know when to seek help* (*view the 'when to speak to a health professional' box near the top of this page for guidance).

Each foot is made up of 26 bones and over 33 small joints, which work with ligaments, muscles and tendons. These joins create a structure that can be both stable, yet also flexible and adaptive to its environment.

The majority of musculoskeletal conditions get better within six to eight weeks although sometimes they can persist for longer, but this doesn’t mean there is something seriously wrong.

However, rarely, musculoskeletal symptoms can be caused by something more serious and it is important for you to know when to seek help* (*view the 'when to speak to a health professional' box near the top of this page for guidance).

Due to its complexity, there are many causes of foot and ankle pain. Some of the common ones are:

  • Poor fitting, incorrect or unsupportive footwear
  • Change in activity (e.g. a change of job or training schedule)
  • Being overweight
  • Natural ageing
  • irritation of the nerves or soft tissues of the heel and foot.
  • thinning of the heel fat pad
  • Trauma (impact e.g. a heavy object falling onto your foot)
  • Conditions e.g. Arthritis (which may affect you, as well as the way your feet work).
  • Fractures of the foot and ankle bones.

Sometimes pain or different sensations like numbness or tingling in the feet may be referred from other parts of the body. This is sometimes called referred pain.

There are many causes of heel pain. One of the most common causes is a condition called plantar fasciopathy. A lot of people may mention heel spurs as being a cause of pain. These are often seen in people with plantar fasciopathy, but are not considered the cause of the pain.

The Achilles tendon is the thick cord like structure that can be felt at the back of the ankle. It is a very strong tendon which attaches the calf muscles (gastrocnemius and soleus) to the heel bone (calcaneus),and works when the heel raises (on tip toe) such as when walking or running. Most injuries to the Achilles tendon are either traumatic or issues with inappropriate loading over time. For example, increasing training schedules too quickly, or taking up a new activity you are not used to.

Ankle sprains occur when you roll, twist or turn your ankle in a forceful way. This can result in injury to the ligaments that support your ankle joint. Most sprains happen when you twist your foot inwards, resulting in pain to the outside (lateral) ligaments.

Many ankle sprains do not require professional intervention, but if the bone is very tender, or you are unable to take any weight on the ankle after injury, it is sensible to get it checked by a professional to rule out a fracture.

The best initial treatment is to try and reduce the load on the affected leg by modifying your stance or footwear, taking more regular breaks and/or using walking aids.

Getting the correct trainers properly fitted for sport, or wearing shoes that offer some cushioning if you are on your feet for long periods may help. If you have particularly high or low arches you may benefit from wearing insoles (orthotics) in your shoes. Gentle stretches can help alleviate some foot pain. Doing gentle stretches to the calf and plantar fascia will also most likely help.

In addition to the treatments mentioned, reducing mileage (or limiting hills) and pacing activitycan help. You can also rub some anti-inflammatory cream directly into the painful area to help relieve discomfort. If these self-treatments do not seem to help after a week or two, you should seek further professional help.

If these measures do not settle the pain, or indeed make things worse, you should seek a professional opinion.

Achilles tendons can rupture. This usually occurs when ‘pushing off’ through the toes (when running, jumping etc). If you feel as if you have been hit in the back of the ankle, hear a loud pop, or are unable to move the toes and ankle downwards (pointing toes), it is important to seek immediate medical advice.

PRICE – Pressure, Rest, Ice and Elevation

It is helpful to apply an ice pack as soon as possible to the site of pain. Use a cold compress or a bag of frozen peas wrapped in a tea towel for 10-15 minutes every two to three hours. Do not apply ice directly to your skin, as this can cause skin damage.

Try to rest your foot/ankle from longer periods of standing or activity and elevating may also help with swelling. It is important to protect foot/ankle from further injury (an appropriate ankle/foot splint or brace may be beneficial for severe injuries). The use of crutches may be necessary, but it is good to try and take as much weight as is comfortable through the foot and ankle.

If your sprain is mild, your ankle/foot should begin to feel a bit better after two to three days. It is important to gradually reintroduce movement and encourage gentle walking. Move the ankle and foot through all movements as pain allows. Writing an imaginary alphabet with your foot and ankle is a good starting exercise.

If your sprain is more severe and not settling, it is important to seek professional advice.

In most cases, foot pain will not become persistent and with a change of footwear and simple exercises you will see improvement.

Injury to foot/ankle tissues usually improve in six to twelve weeks, but if your pain is not improving it is important to get a professional opinion. Some foot conditions do go on to become persistent and need long-term management such as arthritis.

Much of this management will be things you can do yourself after guidance from a professional.

You can follow these videos:

Initial exercises:

Ankle Pain:

Or you can also make use of the following exercise programmes where appropriate:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Heel and sole of foot pain:

 

 

 

Following an injury it is important to seek professional if your symptoms are becoming worse or are not showing any signs of improvement within a few days. 

If you are struggling to walk a minor injury unit may be the best setting but remember that your GP surgery may have lots of different practitioners (such a physiotherapists, podiatrists and nurses) who can help decide if you need further investigation and offer advice.

Painful foot/ankle conditions can be frustrating to live with, however, many people see improvement with self-management advice and trying these exercises:

A physiotherapist will carry out a full thorough assessment of you. This will include:

  • taking a detailed history of your pain/injury, and
  • details about your medical and family history

They will then do a physical assessment to see how you walk and move including how your muscles, joints and nerves are working in your foot.

They will discuss with you the options available, and the best treatment programme that fits your needs. This may include a range of options such as:

  • a home exercise programme for strength, mobility and balance
  • Advice on pain management and activity levels
  • And sometimes hands-on treatment e.g. stretches, mobility, taping or applying a splint but only as part of a the main rehabilitation programme

Your physiotherapist will monitor your progress with the treatment plan, and help you to choose the right treatment option to get you back to your normal daily life.

A physiotherapist can guide you on:
  • exercises to improve movement and strength
  • graded loading/strengthening
  • footwear advice
  • changing your activity level or modifying tasks
  • reducing load of tissues
  • pain management
  • how to improve your balance
  • the need of walking aids

They may also guide you to a specialist or your GP if further investigations are needed. A podiatrist may further help with specialist insoles once you have begun exercises to address tightness and weakness.

When should you self refer?

Most foot and ankle pain will settle naturally in time with little or no help. Most people do not need further treatment or investigations, and your physiotherapist is ideally placed to advise if you do. If the above self-help information is not improving your symptoms within 6-8 weeks or if your symptoms are getting worse, then see a healthcare professional. To do this, you will need to fill in our self referral form.

Please find below information on foot/ankle conditions and some other useful information: 

The information on this page is adapted from: https://www.csp.org.uk/conditions/managing-pain-home/managing-your-ankle-pain and from https://www.csp.org.uk/conditions/foot-pain. Please note: This information is not a replacement for professional help but may aid you and any further information or advice given to you by a medical professional. If you are accessing this site for self-help information in the absence of professional advice, please be aware that the advice and/or exercises may not be suitable for you. If you have any concerns or in the event of any problems, please seek professional advice.

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