Ankle Pain

Have you ever experienced Ankle & foot pain? Have you ever wondered what is the cause of the pain? Or why are you feeling that pain? Do you want to eliminate that pain? Or at-least control it, maybe reduce it.

Well, today I’ll be discussing a few cases of foot & ankle pain that might be the cause of your pain.


Disclaimer: If you feel any pain and discomfort, before following any of the exercises or self diagnose yourself with a specific condition, go to a licensed doctor first to get your ankle & foot inspected before performing any of the exercises mentioned in this article.

I am a licensed Physiotherapist, CPT, CNC, and SNC certified anything I mention in my articles are my own opinions and based on my own judgement from my experience in practising in the field of rehabilitation.

Do the exercises on your own discretion

What are the common ankle cases?

There are 3 common injuries or conditions that occur in the ankle & foot complex, and they are Ankle sprains, Achilles Tendinitis, and Plantar Fasciitis

Next is Achilles Tendinitis, from the word itself -itis, means inflammation of the Achilles tendon, it is a repetitive use syndrome, due to constant trauma or use of the tendon, it could happen from exercising or simply running on your tip toes while being deconditioned, some management for Achilles tendinitis is a hot bath, which is best in water not exceeding 45 degrees Celsius for 30 mins when the pain is felt, and doing a mixed exercise of leg raises for strength and self stretching for lengthening the muscle fibres and relaxation.

Lastly Plantar Fasciitis, which is usually a genetic issue, like foot shape, or maybe it could be due to habit, how you walk, management for plantar fasciitis is strengthening, especially the really deep and minute muscle of the foot, a very quick exercise is towel crumpling with your foot, fold then straighten, next is pain management which is usually from the heel all the way to the ball of your foot, from the name -itis which means inflammation of the plantar fascia, which is simply the bottom of the foot, now to manage the pain it is best to heat up the muscle as quickly as possible, so foot raises, self stretching, and icing the area.

Next I will be going into more detail about each condition, and why these managements were chosen.

So first is “Ankle Sprains” it usually occurs in athletes, especially during intense activities, a wrong landing or a trauma to the area, and you hear a pop sound, and swelling occurs, now swelling occurs due to the body’s response of the situation by rushing blood to the area to help repair what is left of what happened, now as for what to do next, is definitely the emergency protocol which is P.O.L.I.C.E, now what is POLICE emergency protocol, it contains 6 elements, let's discuss them in detail, P stands to protect the area for the first few days, use assistive devices, keep the area safe and restrict movement, the body needs time to repair itself, next is O and L for Optimal Loading, which is when you start doing gentle motions in the joint usually it is done passively by a helper or caregiver, the third is Ice, which is a management for the swelling or edema in the affected area, and it may help in pain management,

Fourth is Compression, you may be advised to use compression stockings or socks that compress the area after icing or during icing to help reduce the swelling further, and Lastly is E for Elevate, now elevate is very important, it helps in circulation of blood in the area that is affected, as you elevate the affected area above the heart, in conjunction with other managements, will help circulate new blood to the affected area which speeds up the healing process.

There are other ligaments in the foot that might get sprained or torn completely, but the most common are the ATFL, and CFL in the lateral compartment of the ankle joint complex, now let's discuss management and priorities when treating your ankle sprain, the first thing is to identify if it’s a complete or incomplete tear, you know this through special tests to the ankle, the easiest is “Talar Tilt” which is simply grasping the leg with one hand, and with the other you invert the foot, then you palpate the lateral compartment for a ligamental structure, if you can feel the ligament then it is an incomplete tear, but if it’s absent then it is a complete tear, now moving on to exercises, when the swelling is gone, it is time to get back your range of motion and confidence. 

For the first exercise is "Figure of 8" exercises, which is simply doing a figure of 8 drawing with your toes pointing forward in a controlled manner, to improve the range of motion and impose confidence in the movement of the joint after a long period of time of rest, next is stretching, due to a long period of rest, some muscles might be shortened, so stretching in all planes of the ankle joint is very important,

Next is limb loading, so actually standing on your foot, you might be hesitant at first to stand on it, so it is best to have someone spot you and load on the limb in segments, so you don’t have to put your full weight on your foot, which is why you can use a weighing scale to determine how much weight are you loading on your foot, typically start at 20KGs and work your way up in segments of 5KGs or if you are confident just keep loading multiples so for examples initially you start with 20KG, no pain, next is 40KG, no pain, so next is 60KG alright a little bit of pain, but it is tolerable, so stick to 60KG for a while until the pain goes away, and you are confident in moving forward with the load, next is joint stability, this is a more technical, as in when you are done with being able to stand freely with no help from anyone on both feet, you will progress to standing only on one foot, for a small period of time, which is usually 1minute that is timed, of course the first time you do this, you need someone to spot you,

Next when you are done with this you progress to an exercise called star excursion exercise, which goes as follows, you draw a star on the ground which looks slightly like an asterisk with electrical tape or whatever tape you have around, and as you are standing on the affected foot, you touch with the unaffected foot on all the sides of the surrounding tape, usually this is more advanced and prescribed for athletes for right before integration back into sport, which isn’t always the case, and I believe everyone should try this exercise, I personally find it challenging, now that is all for ankle sprains, moving on to "Achilles Tendinitis".

First approach to Achilles tendinitis should be complete or incomplete tear, now logically speaking if it is a complete tear, then you basically have excruciating pain in the area, and you can’t move your ankle, because the Achilles tendon is the only one responsible for foot plantar flexion, but a quick special test to determine if the Achilles tendon is completely torn or not is called the Thompson Test, which is basically you laying down on your face, and the physiotherapist squeezes your calves simulating a contraction, if your foot doesn’t move then, it is a complete tear, which is tip toeing, now lets talk about incomplete and post-surgical situation, same protocols done in ankle sprains will be done here,

First is POLICE, next is restoring Range of motion, stretching, lengthening the local muscles, next is strengthening, now strengthening here is very important, if you are post surgery you might want to take it easy with a simple resistance manually done with both your hands, so simply be in a long sitting position, place the towel under your toes, and plantar flex your ankle, while applying a comfortable resistance unto your foot, next would be using elastic bands for additional resistance, next is limb loading, so same principles used in ankle sprains will be used here, next then would be both legs calve raises, transitioning into single affected leg calve raises, now calve raises is probably the only exercise you can do systematically to improve the Achilles tendon sturdiness and load it with your full weight, so then the only way to progress this is to carry weights and do calve raises by the edge of a stair or such, now let's not forget; Please, throughout any of these exercises, have someone spotting you, the least you want is another accident happening and being hospitalized or feeling more pain, now let's move on to our last condition which is,

Plantar Fasciitis, which is also known as flat foot, now this condition is quite tricky and annoying at the same time, you have morning pain in the area, you move your foot, you feel pain, you stretch it you feel pain, it is quite annoying, and sadly it could be simply due to your genetics, as in how your foot is shaped, the pain that you feel is usually due to micro-tears to the structures in the Plantar Fascia due to their chronic elongation, which means they are being stretched, not intentionally, non-stop for a very long time, it could be due to wearing a sole of the shoe that doesn’t support the transverse nor longitudinal arches of the foot, which would cause the foot to flatten elongating all the structures in the fascia, which when overstretched during walking, would cause pain and micro tears to the structures, now lets talk about the managements for Plantar fasciitis,

Our first concern in Plantar Fasciitis is the pain when you wake up, you have to fight through the pain, and stand on your feet, go to your kitchen, and grab the bottle from last night that you filled with water, and simply roll it under your foot for 5 minutes, it helps with the pain, and swelling due to the micro tears, so before strengthening you need to warm up the muscles first before we talk about strengthening, so wear a comfortable shoe with an insole that supports the arches of the foot and go for a 30 mins walk, or just submerge your foot in warm water not exceeding 45 degrees for 30 mins before doing the exercises,

Let's talk about strengthening the muscles that support the transverse and longitudinal arches, so same with ankle sprains, you need to do towel crumpling, especially the inversion action, which is pushing the towel towards you rather than away from you, next is using exercise bands for inversion of the foot, to strengthen the anterior tibialis which supports both longitudinal and transverse arches of the foot due to its insertion location.

Calve raises can help indirectly due to the nature of the exercise, when you weight load on your toes, you elongate the structures of the bottom of the foot, this is why I put this exercise at the end, due to its minute effect on eliminating the pain and strengthening specific structures.

Last exercise I'd like to mention is progression of unstable surfaces, it benefits all patients affected by ankle injuries and instability, you may start with a flat surface, progressing to an uneven surface, and your final destination would be a wobble board, but that is usually unnecessary due to the fact that wobble boards are final progressions for high achieving athletes.

Please seek a medical attention in person. They will be able to check on your condition, do an assessment, and accurately diagnose your condition, and prescribe an action plan, or refer you to a physiotherapist for full body assessment and rehabilitative intervention.

"All my services are done with the intention to help you,

I wish you a fast & full recovery"