Physiotherapy for Foot and Ankle Pain

Physical therapy can reduce pain in the foot or ankle and help you resume your activities. Treatment depends on the identified problem, known as the diagnosis. Plantar fasciitis affects the band of tissue under the foot. An ankle sprain injures one or more ligaments—the connective tissues that hold bones together. Achilles tendinopathy causes pain in the tendon that connects the calf to the heel. This guide explains treatments, recovery times, and steps you can take at home.

How does physiotherapy treat foot and ankle pain?

Physical therapy treats foot and ankle pain through tailored exercises, manual techniques, and advice on your activities. The evaluation helps determine which treatments are best suited to your specific problem and goals.

A systematic review identifies studies that address a specific question and meet defined criteria, and then assesses their quality¹. A 2015 review of injuries to the muscles, tendons, and ligaments of the leg, ankle, and foot found varying results depending on the specific condition². For example, certain Achilles tendon exercises provide greater relief from symptoms than a splint, a device that restricts movement. After certain sprains, a supervised program of exercises and guidance yields results similar to those achieved through at-home exercises and guidance.

In a randomized clinical trial, participants are randomly assigned to treatment groups. This assignment reduces certain risks of bias in the comparison, though it does not eliminate them all³. A review of three trials following a lateral sprain—on the outer side of the ankle—reports improvements in pain, mobility, and the ability to perform daily activities⁴. The treatments compared differ: one trial compares manual therapy and exercises to exercises alone; another adds techniques targeting muscles and their fascia to an already combined treatment regimen; and the third compares supervised treatment combined with home exercises. The favorable results therefore do not all measure the same additional intervention.

A practice guideline compiles recommendations based on research and clinical judgment. The 2021 guideline on heel pain first recommends stretching, taping, and tailored advice⁵. Taping involves applying adhesive tape to the skin to support the foot. The physical therapist then tailors the treatment to your symptoms and activities.

The foot and ankle consist of bones connected by joints and ligaments. Muscles pull on tendons to produce movement. The evaluation aims to determine which movements or weight-bearing positions trigger your symptoms and which activities you would like to resume.

Treatments may combine the following procedures:

• Therapeutic exercises: These exercises strengthen muscles, improve flexibility, and train proprioception—your ability to sense the position of your foot.
• Manual therapy: The physical therapist moves the joints or applies pressure to the muscles and surrounding tissues.
• Education: These explanations help you understand your problem and choose the right steps to take in your daily life.
• Adjusting Activities: You adjust the duration, intensity, or frequency of your efforts at work and during exercise.
• Footwear Advice: A physical therapist can help you choose shoes that are comfortable and suitable for your activities.

To better understand the anatomy and issues affecting this area, check out our comprehensive guide to foot and ankle pain.

What foot and ankle problems can be treated with physical therapy?

Physical therapy can help treat plantar fasciitis, ankle sprains, Achilles tendinopathy, and various types of forefoot pain. It is also used to treat certain bone injuries following a medical evaluation. The choice between non-surgical treatment, medical management, and surgery depends on the problem, its progression, and your goals.

Plantar fasciitis

Plantar fasciitis is a common cause of heel pain⁶. The plantar fascia is the band of tissue that connects the heel to the toes beneath the foot. The 2021 guide recommends stretching this band, taping, and advice on activities and footwear⁵. The 2023 guidelines also recommend strengthening the foot and ankle and manual therapy to reduce pain and improve functional ability⁷. This treatment progresses based on your response.

The program may include the following activities:

• The stretches target the calf and the band of tissue under the foot.
• The exercises gradually strengthen the muscles of the foot and ankle.
• Manual therapy targets restrictions in movement to reduce pain and make it easier to perform daily activities.
• The advice focuses on shoes and, if necessary, orthotics—insoles that support the foot or alter the way weight is distributed.

The physical therapist will monitor, in particular, your pain when taking your first steps and your tolerance for walking. If this morning pain persists, the 2023 guidelines recommend wearing a night splint for one to three months⁷. This brace keeps the foot in a stretched position while you sleep. Orthotics can complement other treatments; they are not recommended as the sole treatment.

Ankle sprain

Lateral sprains—those affecting the outer side of the ankle—are common among ankle sprains, with the prevalence varying depending on the population studied.⁸ The 2014 review included 181 prospective studies, which track participants over time rather than looking back⁸. It concluded that lateral sprains are the most commonly observed type of ankle sprain. The number of new cases—known as incidence—varies by gender, age, and activity level. Rehabilitation—the process of restoring your abilities—focuses on mobility, strength, balance, and the movements involved in your daily activities. It also aims to reduce the occurrence of new sprains, known as recurrences. Seven trials show that exercise-based rehabilitation reduces recurrences between seven and twelve months compared to standard care⁹. Neither the ideal content nor the ideal volume of the program has been established.

For a recent lateral sprain, the gradual resumption of movement and weight-bearing can be part of a treatment plan aimed at returning to activities, tailored to the patient’s symptoms. A synthesis of systematic reviews combines several previously published reviews to identify a common pattern. The 2017 synthesis reports strong evidence in favor of early mobilization after a recent sprain¹⁰. It also reports moderate evidence for the effects of exercises and manual therapy on pain, swelling, and function. The pace of recovery, however, varies from person to person. The 2012 guideline recommends exercises and appropriate support, such as an ankle brace, rather than prolonged immobilization.¹¹

After a sprain, some people are left with an unstable ankle that gives way or lacks support¹². A 2016 review estimates that about 20% develop this persistent instability, known as chronic instability¹². It distinguishes between the sensation of the ankle giving way and excessive movement between the bones, which is related to the ligaments. This estimate varies depending on the population and the definitions used. Rehabilitation takes into account mobility, strength, balance, and the target activities.

The 2021 guidelines recommend protecting the ankle, gradually resuming weight-bearing, and following a structured exercise program¹³. A severe sprain may require immobilization for up to ten days. The following steps may overlap depending on your condition:

Achilles Tendinopathy

Achilles tendinopathy causes pain in the tendon that connects the calf to the heel. It can affect both athletes and less active individuals. A 2023 review supports progressive exercises, particularly eccentric exercises¹⁷. In these exercises, the muscle exerts force while lengthening, for example, to control the lowering of the heel.

Exercises that gradually increase the load on the tendon are the initial treatment for an injury to its middle portion, above the heel¹⁸. The 2024 guidelines recommend at least three sessions per week, with as much exertion as tolerated. This specific frequency is based on theoretical or fundamental data, rather than on trials directly comparing different frequencies.

A program specifies the resistance, repetitions, and pace. A review of twelve studies examines several treatments for the middle portion of the tendon¹⁹. Among the comparisons of exercise programs, none clearly outperforms the others in terms of pain or functional activities. Lowering the heel below the level of a step is an option for this condition, provided the movement is well tolerated.

The insertional form causes pain at the tendon’s attachment to the heel bone. For this form, a 2025 consensus emphasizes the range of motion that brings the foot toward the tibia²⁰. This consensus reflects the judgment of 17 experts; it does not prove which program is superior. Initially, the exercises can be performed without lowering the foot below floor level. The range of motion is then gradually increased based on the patient’s tolerance and the activities they aim to resume.

Progress in Achilles tendon healing is measured by pain levels and the activities you can perform. A review tracks the progress of 31 groups of patients over a period ranging from two weeks to six months²¹. Pain and functional ability improve as early as the second week, with average progress appearing to peak around the twelfth week. These observations pertain to the middle portion of the tendon. They describe changes over time without isolating the effect of treatment by comparing it to a group that did not perform exercises. An average does not guarantee your specific recovery time. The physical therapist will adjust the program based on your symptoms during exercise and how they change after each session.

Heel spur

A Lenoir spur is a small bony protrusion on the heel bone. It can be present in people who do not experience pain. The imaging findings should therefore be interpreted in conjunction with the patient’s symptoms and physical examination. Among 74 people with unilateral plantar fasciitis, a spur was visible in 85.1% of the painful feet²². The spur was also present in 71.6% of the opposite feet, which remained pain-free. The presence of the spur alone did not, therefore, explain the symptoms.

Another X-ray study compared people with and without a heel spur. A heel spur was associated with more foot pain, but it could also be present without causing pain and did not prove to be the cause of the symptoms.²³ People with a bone spur also reported greater difficulty with activities involving the foot²³. The authors note that a heel spur may indicate other associated problems, without itself being the cause of the pain.

According to the assessment, treatment options may focus on pain, the amount of exertion tolerated, and activities:

• Stretching exercises improve flexibility in the calf and plantar fascia.
• The exercises gradually build up strength in the foot and calf.
• Orthotics can complement treatment if they improve comfort or enable certain activities.
• Manual therapy can reduce pain and improve foot mobility.

Off-the-shelf and custom orthotics can complement the treatment of plantar fasciitis; custom orthotics have not been shown to be generally superior²⁴. In a trial involving 135 people, both types produced similar results²⁴. Compared to a thin, flexible insole used as a control, they slightly improved functional ability at three months. The small benefit observed for pain remains uncertain. At twelve months, the primary measures no longer showed a clear difference. These results apply only to a specific condition: plantar fasciitis.

Shin splints

Tibial periostitis is a common injury among long-distance runners. This condition can occur when repeated stress exceeds the tissues’ ability to recover. The medical term for this condition is medial tibial stress syndrome, which refers to pain along the inner edge of the tibia, the large bone in the lower leg. A 2013 review, which synthesizes the results of several studies, reports that it affects between 5% and 35% of runners²⁵. It links the risk to several personal factors and movement patterns, without identifying a single cause.

Periostitis can develop when the amount of exercise, recovery, and other factors all play a role. The duration and intensity of your workouts should be adjusted based on your condition, your activities, and the symptoms you experience in the hours that follow.

Treatment may include a combination of the following measures:

• You temporarily reduce the duration or frequency of your workout.
• The physical therapist can work with you to modify a movement to see if it makes an activity more comfortable.
• These exercises gradually strengthen the calf and foot muscles.
• You should gradually resume running, without adhering to a fixed percentage increase. Increasing running distance according to a fixed rule has not been shown to provide protection against injuries in beginner runners.²⁶ A study of 532 beginner runners compared a 13-week program based on the 10% rule to a traditional program spread over eight weeks²⁷. The number of injuries did not decrease with the 10% rule. A single trial focusing on a specific program does not prove that any gradual progression is ineffective.

Hallux valgus (bunion)

Hallux valgus, commonly known as a “bunion,” causes the big toe to deviate toward the other toes and forms a bump on the side of the foot. This condition is common in adults and becomes more common with age. Prevalence is the proportion of people affected at a given time. Based on a synthesis of studies, a 2010 review estimated the prevalence at 23% among adults aged 18 to 65²⁸. It rises to 35.7% after age 65 and is higher among women. Physical therapy can address symptoms, function, and footwear choices, and aids such as toe spreaders or wide-toed shoes are sometimes used in addition. Correcting the deformity remains uncertain: in the 2022 review, pain relief appears more likely than a change in the angle of the big toe²⁹. Four studies in that review nevertheless report a significant reduction in the angle with certain non-surgical treatments. The overall confidence in the evidence remains low, and these treatments do not guarantee that the toe will straighten.

Non-surgical treatments may include the following options:

• These exercises strengthen the small muscles in the foot.
• The physical therapist gently moves the joints to improve their range of motion.
• Shoes with a wide toe box and a low heel provide more room for the toes.
• Toe separators are small devices placed between the toes.

Metatarsalgia

Metatarsalgia refers to pain under the ball of the foot, near the base of the toes. A 2021 review describes it as a common reason for seeking medical care, particularly among middle-aged women³⁰. The term refers to a symptom, not a single cause. The evaluation focuses on identifying problems related to weight-bearing, joints, nerves, or bones.

Physical therapy can be effective in several ways:

• The physical therapist checks to see if a different shoe or a different type of support relieves pressure on the forefoot.
• These exercises strengthen the muscles of the foot.
• These tailored exercises improve toe mobility.
• These tips will help you choose the right shoe modifications.

Morton's Neuroma

Morton's neuroma is a thickening of the tissue around a nerve in the forefoot. It can compress or irritate this nerve and cause pain near the toes³¹. Changing shoes and using insoles are initial non-surgical treatment options³². A shoe with a wide toe box and a low heel provides more room in the forefoot. A small cushion placed just behind the base of the toes can reduce pressure on the area. Studies remain limited; your response will guide the continuation of this treatment.

Physical therapy treatments take many forms:

• The physical therapist recommends shoes that provide enough room in the forefoot.
• The physical therapist gently moves the joints near the base of the toes.
• A cushion placed behind the base of the toes can redistribute the pressure to relieve the sensitive area.
• You should temporarily adjust any activities that make the pain worse.

A review also reports favorable results from mobilization and manipulation techniques for pain, compared to a control treatment³¹. However, there is little evidence supporting the use of these movements, performed by a therapist, for Morton’s neuroma; no single treatment stands out as clearly effective.

Stress fracture

A stress fracture is a small crack in the bone caused by repeated stress. In athletes, the metatarsals—the long bones of the forefoot—are among the most common sites of stress fractures. A 2017 review indicates that the most common stress fractures of the foot and ankle involve the second and third metatarsals³³. The posteromedial tibia—the back of the inner edge of the leg—and the calcaneus, the heel bone, are also among the common sites. Physical therapy can support a return to activities; medical evaluation and bone health factors remain important.

Treatment depends on the location:

• Low-risk fractures require reduced physical activity and, in some cases, a protective shoe. A return to normal activities depends on bone healing and medical advice. A 2017 review reports that rest and limiting physical activity are generally sufficient³⁴.
• High-risk fractures require stricter immobilization and close medical monitoring. At high-risk sites, the same review describes greater crack extension, displacement of bone fragments, and delayed union³⁴. Union is the healing of the broken bone. These fractures require cessation of activities that place stress on the bone and an evaluation by a physician who specializes in bone injuries. The exact location determines the level of risk, and not all metatarsal fractures are classified in the same way.

What does a physiotherapy assessment for the foot and ankle look like?

A physical therapy evaluation of the foot and ankle begins with a discussion of your pain history, continues with an assessment of your range of motion, strength, and gait, and concludes with a treatment plan developed in consultation with you.

The physical therapist will ask you questions and assess your abilities before proposing a personalized plan³⁵. Together, you’ll set goals related to your activities.

What happens during the assessment

The physical therapist will ask you questions about the following:

• Please describe when your pain began.
• You explain what makes your symptoms worse or better.
• Please list your previous injuries.
• You describe your daily activities and sports.
• List the activities you want to find.

The exam assesses several aspects of your abilities:

• The physical therapist observes the position of your leg and foot.
• The physical therapist observes the way you walk.
• The physical therapist measures the range of motion in your foot and ankle.
• The physical therapist assesses your muscle strength.
• The physical therapist checks for areas that are painful to the touch.

The physical therapist selects tests based on your symptoms:

• The anterior drawer test assesses ligament stability as the physical therapist gently moves the foot forward.
• The compression test checks for signs of a sprain in the joint between the two bones of the leg, just above the ankle.
• The knee-to-wall test measures ankle mobility when the knee moves forward and the heel remains on the ground.
• Balance tests, such as standing on one leg, assess a skill that is useful for your daily activities.

You and your physical therapist will develop the plan together:

• You set specific goals and measurable benchmarks related to your activities.
• You agree on the frequency of the sessions.
• You'll learn the exercises to do at home.
• You determine which activities to temporarily modify.

According to the findings, the first session may include advice, exercises, or a referral to another professional.

What physiotherapy techniques are used for the foot and ankle?

Physical therapy techniques for the foot and ankle include exercises, manual therapy, advice, and certain complementary treatments, such as ice or shock wave therapy.

The physical therapist selects treatment options based on your condition, your goals, and the progress observed.

Therapeutic Exercises

Exercise plays a central role in care. Gradually increasing the intensity allows the program to be tailored to your abilities. A review of numerous studies describes the benefits of exercise on daily activities and quality of life for various muscle and joint conditions³⁶. However, the methodology of most of these reviews is of very poor quality; the optimal design of each program remains unclear.

A 2018 review examines exercises for the Achilles tendon, sprains, and heel pain³⁷. Patient groups often show significant improvement between the start and end of follow-up. These before-and-after comparisons do not distinguish the specific effect of the exercises from natural progression or other treatments. The results support the value of tracking your progress, without establishing a universal “ideal dose.”

• Eccentric exercises: You control the lowering phase of a movement to work the muscle as it lengthens.
• Isometric strengthening: You contract your muscles without moving the joint, for example, by keeping your heel raised.
• Proprioception exercises: Balance training enhances the sense of foot position and helps the body make adjustments.
• Stretches: You'll work on improving the flexibility of your calves, plantar fascia, and toes.
• Functional exercises: You practice movements that resemble your daily activities or sports.

Manual therapy

Manual therapy encompasses techniques in which the physical therapist uses their hands to treat your tissues.

• Joint Mobilization: The physical therapist gently moves a joint to improve its range of motion and reduce pain. The 2021 Ankle Guide recommends these techniques along with exercises¹³. The physical therapist assesses your pain and range of motion at the beginning and end of the session.
• Soft-tissue mobilization: The physical therapist applies pressure or gliding movements to the muscles and the surrounding tissues. A review of 26 trials found a reduction in pain or short-term improvement in functional ability for certain back, knee, or shoulder problems³⁸. Massage does not appear to be clearly superior to other active treatments. These results do not demonstrate the same benefit for the foot or ankle.
• Deep transverse massage: The physical therapist applies repeated pressure across a tendon or muscle. A 2012 review reports favorable results from combined treatments for certain elbow or shoulder conditions³⁹. The studies are too diverse to draw conclusions about a common effect, and they do not isolate the specific effect of this type of massage. Data specific to the Achilles tendon are particularly limited. Massage can complement treatment but should not replace prescribed exercises.

Following a recent sprain, a review of three trials involving a total of 180 people reports benefits from treatment combining exercises and manual techniques⁴. Improvements were observed in pain, upward and downward foot movement, and functional activities. One of the trials added muscle-targeted techniques to an already combined treatment regimen; therefore, the comparators were not identical. In that trial, the additional benefit did not reach the threshold for a clinically significant difference. Swelling was not included in the pooled results of this review.

Complementary Treatments

Certain complementary treatments may help manage symptoms:

Ice applied after a recent sprain may provide temporary relief for some people. Studies do not confirm a significant benefit when ice is used alone. A review of 22 low-quality trials found little data on combining ice with exercises or on the best way to apply it⁴⁰. Wrap the ice in a cloth and limit application to 20 minutes. After a new sprain, avoid heat during the first few days⁴¹. For older pain, heat or cold can be used for comfort, depending on your preference. Avoid these treatments if you have reduced sensation or circulation; seek advice in such cases.⁴²

Shockwave therapy (ESWT) is an option for cases of plantar fasciitis that do not respond to initial non-surgical treatment. The acronym ESWT stands for “Extracorporeal Shock Wave Therapy” and refers to high-intensity sound waves applied to the skin. Initial treatment includes non-surgical approaches. The 2021 guidelines recommend shockwave therapy as an additional step when the basic approach is insufficient⁵. It reports short-, medium-, and long-term effects on pain. Shockwave therapy may be considered when symptoms persist despite adequate, targeted physical therapy; its appropriateness depends on the diagnosis, the response to initial treatment, and patient preferences.

A doctor may recommend a cortisone injection to temporarily relieve certain symptoms of plantar fasciitis. The benefits must be weighed against the possible complications, including a tear in the fascia⁴³. In a review of ten trials, relief typically lasts four to twelve weeks⁴³. Cortisone belongs to the class of corticosteroids, which are medications that reduce inflammation.

Another study included 155 people who had experienced a fascial tear; 130 had received a local corticosteroid injection⁴⁴. These findings do not indicate the risk of rupture among all individuals who received the injection. Nor do they, on their own, prove that the injection caused the rupture. Your doctor will explain the benefits and risks specific to your situation.

The available data do not support the use of therapeutic ultrasound to treat an ankle sprain. These devices emit sound waves that are inaudible to the human ear. A 2011 Cochrane review found no clear difference in five trials comparing the active device with a sham device⁴⁵. Any effects are considered small and likely of little importance to patients. This conclusion regarding the device does not call into question the exercises and other treatments recommended for ankle sprains.

Patient education

Education helps you understand your problem and manage your activities. Explanations are useful for making various decisions:

• You choose the actions that best suit your daily situation.
• You adjust your activities according to the agreed-upon guidelines.
• You can recognize the signs of improvement or worsening.
• You should review the plan with your physical therapist whenever your symptoms or abilities change.

How long does recovery take with physiotherapy?

Recovery may take a few weeks after a mild sprain and several months for Achilles tendinopathy or persistent heel pain. Most sprains begin to improve within two weeks; a severe injury may take several months⁴¹. Returning to your activities also depends on your walking ability, strength, and balance—not just on how much time has passed.

The severity of the sprain determines the initial treatment. You can then resume activities based on your pain level, range of motion, and ankle stability.

Heel Pain: The 2021 guide generally recommends four to six weeks of basic treatment before considering the next step⁵. This guideline, which is also based on clinicians’ judgment, is used to reassess the treatment plan; it does not guarantee a cure within six weeks.

Achilles Tendon: Studies show progress as early as two weeks and a significant average improvement around twelve weeks²¹. Recovery may continue beyond that point.

Tibial periostitis: A return to activity depends on the resolution or reduction of symptoms during walking and exercise. Unusual or very localized pain requires reevaluation to rule out, in particular, a stress fracture.

Stress fracture: The bone often heals in six to eight weeks, but some sites take longer⁴⁶. The doctor confirms that the bone is healing and gives the okay to resume activity. Reduced pain alone is not enough to prove that the bone has healed.

Factors to Discuss During Recovery

• You are having significant, persistent, or unusual pain evaluated.
• You may request an accommodation if the at-home program is difficult to tolerate, understand, or incorporate.
• You are following the recommended changes to your activity level.
• Keep your physical therapist informed of your progress and any challenges you're facing.

• Severe, persistent, or unusual pain goes unevaluated.
• The program is difficult to tolerate, understand, or incorporate into daily life.
• Resuming physical activity exceeds your tolerance level during or after the activity.
• A sustained worsening of symptoms or a loss of ability is not adjusted for.

Session frequency

The frequency of sessions is determined based on assessment, learning, and progress needs, and is then reassessed as changes are observed.

Sessions may be spaced out or end once you have achieved your goals and can continue with the necessary care on your own.

What exercises can I do at home for my foot or ankle?

Home exercises include ankle movements, foot and calf strengthening exercises, balance exercises, and stretching.

Your physical therapist will choose the exercises and determine the appropriate intensity based on your condition. The examples below illustrate the movements; they do not constitute an identical program for everyone⁴⁷. After a fracture or surgery, adhere to the prescribed weight-bearing limits. Stop any exercise that triggers new or sharp pain. For certain tendon issues, tolerable pain may be permitted according to agreed-upon guidelines; how the pain evolves after the session and the following day will then guide any adjustments²⁰.

Mobility Exercises

You are sitting or lying down. Make small, slow circles with your foot, in both directions, without forcing the end of the movement.

You are sitting with your leg extended. Gently point your foot, then bring your toes toward you.

Stand facing a wall with your hands resting on it. Step one leg back, keeping your right knee and heel on the floor. Gently push your hips forward until you feel a stretch in your calf.

Strengthening exercises

Stand with your feet shoulder-width apart and lift your heels while keeping your toes on the ground. Slowly lower yourself back down. The physical therapist will specify the number of repetitions and whether to switch from using both legs to using one leg.

You are sitting with your foot resting on a towel on the floor. Curl your toes to pull the towel toward you, then relax.

Sit down and place an elastic band around the front of your foot. Gently rotate your foot inward, then outward in a separate exercise, against the resistance of the band. The physical therapist will show you how to secure the band and keep your leg still.

Proprioception Exercises

Stand near a counter and lift one foot. Maintain your balance on the other leg, using the counter for support if needed. Increase the duration as you gain better control of the position.

Stand with your weight on one leg near a counter. Gently touch the floor with your other foot in front of you, to the side, and then behind you. Keep your body stable and return to the starting position after each movement.

Specific stretches

Sit down and place the foot you want to stretch on the opposite knee. Gently pull your toes toward your shin until you feel a stretch under your foot. The physical therapist will adjust the duration⁷.

You can stretch your calf and Achilles tendon against a wall, with the knee of your back leg slightly bent and your heel on the floor. If the pain is located where the tendon attaches to the heel, do not force the stretch. Your physical therapist may limit this movement at first; the range of motion will then increase depending on how you respond.

How can you reduce the risk of certain foot and ankle injuries recurring?

Exercises and, for certain activities, an ankle brace can reduce the risk of another^ankle sprain^{.¹⁰, ⁹} No program can protect against all injuries. For other types of foot pain, prevention involves addressing the underlying issue, managing physical activity, and ensuring proper recovery.

Once you've recovered, you can continue with helpful exercises and monitor how your body responds as you resume your activities.

Continue Your Exercises

You can continue to build strength and improve balance after a sprain. The physical therapist will tailor the frequency of your exercises to your activities, your abilities, and your risk of re-injury.

Progress Gradually

Build up gradually. The popular rule of limiting weekly distance increases to one-tenth has not been proven effective: increasing running distance in this way has not been shown to protect beginner runners from injuries.²⁶ The rule was tested among 532 beginner runners²⁷. The 13-week program that followed this rule did not reduce the number of injuries compared to the standard 8-week program. The finding pertains to this specific numerical rule, not the general idea of gradual progression.

For example, increase your running distance very gradually from one week to the next, depending on how well your body handles it.

Choose the Right Shoes

You can choose your shoes based on comfort, activity, and needs:

• The toe box of the shoe provides plenty of room for the toes.
• The support you choose improves your comfort or makes an activity easier.
• The insole remains comfortable throughout the chosen activity.
• You should replace your shoes if their condition, comfort, or support are no longer suitable for the activity.

If high heels affect your symptoms during a specific activity, compare their effect with that of another type of shoe.

Listen to your body

Pain during and after physical activity should be evaluated in light of the diagnosis, function, and the course of the condition. A persistent worsening of symptoms or a loss of function warrants adjusting the level of activity or seeking medical advice.

A follow-up visit can help clarify the diagnosis and adjust the treatment plan when symptoms recur.

Weight, Overall Health, and Goals

If weight is one of the factors that matters to you, the discussion should also take into account your activity level, overall health, and your goals.

When is physiotherapy alone not enough?

Physical therapy alone is not enough if there is a possible fracture, an infection, or severe symptoms that require a medical evaluation. Seek medical attention promptly if the pain worsens despite treatment, if numbness spreads, or if strength decreases. Certain signs require^urgent evaluation ^{.⁴⁸, ⁴⁹, ⁵⁰}

Seek urgent medical evaluation in the following situations:

• Your foot or ankle has developed a new deformity, even without a known injury.
• The pain is severe; you cannot walk or have great difficulty putting weight on your leg.
• Your pain is accompanied by discomfort, dizziness, or nausea.
• You heard a snap, a crack, or a grinding sound at the moment of the injury.
• Your foot is warm, swollen, and painful, or the pain in your foot is accompanied by a fever or chills.
• The swelling increases rapidly, or the redness spreads.
• Intense pain occurs in the shin, even at rest. Sudden, severe pain in the leg requires a visit to the emergency room, as dangerous pressure in the muscles must be ruled out.

Persistent pain or a loss of sensation also requires a medical evaluation. If you have diabetes and are experiencing foot pain, seek^medical advice^{.⁴⁸, ⁴⁹} You cannot diagnose yourself based on these symptoms.

Situations that may require additional medical intervention

• The pain persists, worsens, or further limits your activities despite the adjustments you've already tried.
• You are experiencing increasing numbness or progressive weakness.
• An infection is suspected, especially if the foot becomes warm and painful, if redness spreads, or if you have a fever.
• A fracture or stress fracture is still a possibility, depending on the symptoms and test results.

• Corticosteroid injections: Injections may provide temporary relief for certain conditions; the benefits and risks should be discussed with your doctor. For plantar fasciitis, studies show relief mainly in the short term, lasting four to twelve weeks⁴³. Complications are rare and should be weighed against the expected benefits. Trials focus on specific diagnoses and do not cover all types of foot and ankle pain.
• Custom Orthotics: A custom-made insole can complement treatment depending on the specific issue, comfort needs, and response to other treatment options.
• Surgery: The doctor may recommend surgery when the problem, the limitations, and the treatments already tried warrant it.

Physiotherapy After Surgery

If surgery becomes necessary, physical therapy can support the recovery process depending on the procedure and the surgeon’s instructions. Following ankle fracture surgery, a 2015 review reported that active exercises accelerated the return to work and daily activities⁵¹. The comparison was made with immobilization, and early weight-bearing also tended to shorten the recovery time, though the results of this comparison were inconclusive. The review focuses on surgically treated ankle fractures, and protocols vary depending on the procedure. The program has several objectives:

• The exercises are designed to restore mobility.
• Strength training helps restore strength.
• You can resume permitted activities as you make progress.
• The physical therapist monitors for complications and follows the surgeon's instructions.

How to Book a Physiotherapy Appointment at Physioactif?

You can schedule an appointment at Physioactif directly online, without a doctor’s referral. In Quebec, direct access to a physical therapist in a private clinic is permitted³⁵. Check with your insurance provider regarding reimbursement terms.

The first visit is to discuss your symptoms, function, risks, and next steps with you.

If your symptoms require medical tests or the opinion of another professional, the physical therapist will explain the recommended course of action.

• Please bring your health insurance card.
• Please bring any available imaging results: X-rays, magnetic resonance imaging (MRI), or ultrasound, which produce images of the inside of the body.
• Please bring a list of your medications.
• Please wear comfortable shoes for the gait assessment.

References

Links open in a new tab.

1. Chapter 4: Searching for and Selecting Studies | Cochrane. (Back to section 1)
2. Woitzik E, Jacobs C, Wong JJ, Côté P, Shearer HM, Randhawa K, et al. The effectiveness of exercise on recovery and clinical outcomes of soft tissue injuries of the leg, ankle, and foot: A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Man Ther. 2015;20(5):633-45. (Back to section: 1)
3. Chapter 8: Assessing Risk of Bias in a Randomized Trial | Cochrane. (Back to section: 1)
4. de Ruvo R, Russo G, Lena F, Giovannico G, Neville C, Turolla A, et al. The Effect of Manual Therapy Plus Exercise in Patients with Lateral Ankle Sprains: A Critically Appraised Topic with a Meta-Analysis. J Clin Med. 2022;11(16). (Back to sections: 1, 2)
5. Morrissey D, Cotchett M, Said J'Bari A, Prior T, Griffiths IB, Rathleff MS, et al. Management of plantar heel pain: a best practice guide informed by a systematic review, expert clinical reasoning, and patient values. Br J Sports Med. 2021;55(19):1106-1118. (Back to sections: 1, 2, 3, 4)
6. Tung WS, Daher M, Covarrubias O, Herber A, Gianakos AL. Extracorporeal shock wave therapy shows comparable results to other treatments for plantar fasciitis: A systematic review and meta-analysis. Foot Ankle Surg. 2025;31(4):283-290. (Back to section 1)
7. Koc TA, Bise CG, Neville C, Carreira D, Martin RL, McDonough CM. Heel Pain - Plantar Fasciitis: 2023 Update. J Orthop Sports Phys Ther. 2023;53(12):CPG1-CPG39. (Back to sections: 1, 2, 3)
8. Doherty C, Delahunt E, Caulfield B, Hertel J, Ryan J, Bleakley C. The incidence and prevalence of ankle sprains: a systematic review and meta-analysis of prospective epidemiological studies. Sports Med. 2014;44(1):123-40. (Back to sections: 1, 2)
9. Bleakley CM, Taylor JB, Dischiavi SL, Doherty C, Delahunt E. Rehabilitation Exercises Reduce Reinjury After an Ankle Sprain, But the Content and Parameters of an Optimal Exercise Program Have Yet to Be Established: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil. 2019;100(7):1367-1375. (Back to sections: 1, 2)
10. Doherty C, Bleakley C, Delahunt E, Holden S. Treatment and prevention of acute and recurrent ankle sprains: an overview of systematic reviews with meta-analysis. Br J Sports Med. 2017;51(2):113-125. (Back to sections: 1, 2, 3)
11. Kerkhoffs GM, van den Bekerom M, Elders LA, van Beek PA, Hullegie WA, Bloemers GM, et al. Diagnosis, treatment, and prevention of ankle sprains: an evidence-based clinical guideline. Br J Sports Med. 2012;46(12):854-60. (Back to section: 1)
12. Al-Mohrej OA, Al-Kenani NS. Chronic ankle instability: Current perspectives. Avicenna J Med. 2016;6(4):103-108. (Back to sections: 1, 2)
13. Martin RL, Davenport TE, Fraser JJ, Sawdon-Bea J, Carcia CR, Carroll LA, et al. Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains (2021 Revision). J Orthop Sports Phys Ther. 2021;51(4):CPG1-CPG80. (Back to sections: 1, 2)
14. Bleakley CM, O'Connor SR, Tully MA, Rocke LG, Macauley DC, Bradbury I, et al. Effect of accelerated rehabilitation on function after ankle sprain: a randomized controlled trial. BMJ. 2010;340:c1964. (Back to section 1)
15. van den Bekerom MP, Struijs PA, Blankevoort L, Welling L, van Dijk CN, Kerkhoffs GM. What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults? J Athl Train. 2012;47(4):435-43. (Back to section: 1)
16. Borra V, Berry DC, Zideman D, Singletary E, De Buck E. Compression Wrapping for Acute Closed Extremity Joint Injuries: A Systematic Review. J Athl Train. 2020;55(8):789-800. (Back to section: 1)
17. Sivrika AP, Papadamou E, Kypraios G, Lamnisos D, Georgoudis G, Stasinopoulos D. Comparability of the Effectiveness of Different Types of Exercise in the Treatment of Achilles Tendinopathy: A Systematic Review. Healthcare (Basel). 2023;11(16). (Back to section: 1)
18. Chimenti RL, Neville C, Houck J, Cuddeford T, Carreira D, Martin RL. Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision - 2024. J Orthop Sports Phys Ther. 2024;54(12):CPG1-CPG32. (Back to section: 1)
19. Maetz R, Dubé MO, Tougas A, Prudhomme F, Dubois B, Roy JS. Systematic Review and Meta-analyses of Randomized Controlled Trials Comparing Exercise Loading Protocols With Passive Treatment Modalities or Other Loading Protocols for the Management of Midportion Achilles Tendinopathy. Orthop J Sports Med. 2023;11(5):23259671231171178. (Back to section: 1)
20. Demangeot Y, O'Neill S, Degache F, Rapin A, Asgher U, Alfredson H, et al. Exercise parameters to consider for Achilles tendinopathy: a modified Delphi study with international experts. Br J Sports Med. 2025;59(19):1337-1349. (Back to sections: 1, 2)
21. Murphy M, Travers M, Gibson W, Chivers P, Debenham J, Docking S, et al. Rate of Improvement in Pain and Function in Mid-Portion Achilles Tendinopathy with Loading Protocols: A Systematic Review and Longitudinal Meta-Analysis. Sports Med. 2018;48(8):1875-1891. (Back to sections: 1, 2)
22. Okçu M, Tuncay F, Koçak FA, Erden Y, Ayhan MY, Kaya SS. Do the presence, size, and shape of plantar calcaneal spurs have any significance in terms of pain and treatment outcomes in patients with plantar fasciitis? Turk J Med Sci. 2023;53(1):413-419. (Back to section: 1)
23. Moroney PJ, O'Neill BJ, Khan-Bhambro K, O'Flanagan SJ, Keogh P, Kenny PJ. The conundrum of calcaneal spurs: do they matter? Foot Ankle Spec. 2014;7(2):95-101. (Back to sections: 1, 2)
24. Landorf KB, Keenan AM, Herbert RD. Effectiveness of foot orthoses in treating plantar fasciitis: a randomized trial. Arch Intern Med. 2006;166(12):1305-10. (Back to sections: 1, 2)
25. Newman P, Witchalls J, Waddington G, Adams R. Risk factors associated with medial tibial stress syndrome in runners: a systematic review and meta-analysis. Open Access J Sports Med. 2013;4:229-41. (Back to section: 1)
26. Fredette A, Roy JS, Perreault K, Dupuis F, Napier C, Esculier JF. The Association Between Running Injuries and Training Parameters: A Systematic Review. J Athl Train. 2022;57(7):650-671. (Back to sections: 1, 2)
27. Buist I, Bredeweg SW, van Mechelen W, Lemmink KA, Pepping GJ, Diercks RL. No effect of a graded training program on the number of running-related injuries in novice runners: a randomized controlled trial. Am J Sports Med. 2008;36(1):33-9. (Back to sections: 1, 2)
28. Nix S, Smith M, Vicenzino B. Prevalence of hallux valgus in the general population: a systematic review and meta-analysis. J Foot Ankle Res. 2010;3:21. (Back to section: 1)
29. Hurn SE, Matthews BG, Munteanu SE, Menz HB. Effectiveness of Nonsurgical Interventions for Hallux Valgus: A Systematic Review and Meta-Analysis. Arthritis Care Res (Hoboken). 2022;74(10):1676-1688. (Back to section: 1)
30. Cooke R, Manning C, Palihawadana D, Zubairy AI, Khan SH. Metatarsalgia: anatomy, pathology, and management. Br J Hosp Med (Lond). 2021;82(9):1-8. (Back to section: 1)
31. Matthews BG, Hurn SE, Harding MP, Henry RA, Ware RS. The effectiveness of non-surgical interventions for common plantar digital compressive neuropathy (Morton's neuroma): a systematic review and meta-analysis. J Foot Ankle Res. 2019;12:12. (Back to sections: 1, 2)
32. Colò G, Rava A, Samaila EM, Palazzolo A, Talesa G, Schiraldi M, et al. The effectiveness of shoe modifications and orthotics in the conservative treatment of Civinini-Morton syndrome: current status. Acta Biomed. 2020;91(4-S):60-68. (Back to section: 1)
33. Mandell JC, Khurana B, Smith SE. Stress fractures of the foot and ankle, part 2: site-specific etiology, imaging, and treatment, and differential diagnosis. Skeletal Radiol. 2017;46(9):1165-1186. (Back to section: 1)
34. Robertson GA, Wood AM. Lower Limb Stress Fractures in Sports: Optimizing Their Management and Outcome. World J Orthop. 2017;8(3):242-255. (Back to sections: 1, 2)
35. OPPQ. How does it work? (Back to sections: 1, 2)
36. Arora NK, Donath L, Owen PJ, Miller CT, Saueressig T, Winter F, et al. The Impact of Exercise Prescription Variables on Intervention Outcomes in Musculoskeletal Pain: An Umbrella Review of Systematic Reviews. Sports Med. 2024;54(3):711-725. (Back to section: 1)
37. Young JL, Rhon DI, de Zoete RMJ, Cleland JA, Snodgrass SJ. The influence of dosing on the effect size of exercise therapy for musculoskeletal foot and ankle disorders: a systematic review. Braz J Phys Ther. 2018;22(1):20-32. (Back to section: 1)
38. Bervoets DC, Luijsterburg PA, Alessie JJ, Buijs MJ, Verhagen AP. Massage therapy provides short-term benefits for people with common musculoskeletal disorders compared to no treatment: a systematic review. J Physiother. 2015;61(3):106-16. (Back to section: 1)
39. Joseph MF, Taft K, Moskwa M, Denegar CR. Deep friction massage for the treatment of tendinopathy: a systematic review of a classic treatment in light of a new paradigm of understanding. J Sport Rehabil. 2012;21(4):343-53. (Back to section: 1)
40. Bleakley C, McDonough S, MacAuley D. The use of ice in the treatment of acute soft-tissue injury: a systematic review of randomized controlled trials. Am J Sports Med. 2004;32(1):251-61. (Back to section: 1)
41. nhs.uk. Sprains and strains. 2017. (Back to sections: 1, 2)
42. Gloucestershire Hospitals NHS Foundation Trust. Ice and heat therapy. (Back to section: 1)
43. Ang TW. The effectiveness of corticosteroid injection in the treatment of plantar fasciitis. Singapore Med J. 2015;56(8):423-32. (Back to sections: 1, 2, 3)
44. Mosca M, Fuiano M, Massimi S, Censoni D, Catanese G, Grassi A, et al. Ruptures of the Plantar Fascia: A Systematic Review of the Literature. Foot Ankle Spec. 2022;15(3):272-282. (Back to section: 1)
45. van den Bekerom MP, van der Windt DA, Ter Riet G, van der Heijden GJ, Bouter LM. Therapeutic ultrasound for acute ankle sprains. Cochrane Database Syst Rev. 2011;2011(6):CD001250. (Back to section: 1)
46. Stress Fractures of the Foot and Ankle - OrthoInfo - AAOS. (Back to section: 1)
47. Foot and Ankle Conditioning Program - OrthoInfo - AAOS. (Back to section: 1)
48. nhs.uk. Ankle pain. 2022. (Back to sections: 1, 2)
49. nhs.uk. Pain in the ball of the foot. 2022. (Back to sections: 1, 2)
50. nhs.uk. Compartment Syndrome. 2017. (Back to section: 1)
51. Smeeing DP, Houwert RM, Briet JP, Kelder JC, Segers MJ, Verleisdonk EJ, et al. Weight-bearing and mobilization in the postoperative care of ankle fractures: a systematic review and meta-analysis of randomized controlled trials and cohort studies. PLoS One. 2015;10(2):e0118320. (Back to section: 1)