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. If you’d like to first understand the different causes of foot and ankle pain, check out our comprehensive guide to foot and ankle pain.

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 quality ¹. A 2015 review of injuries to the muscles, tendons, and ligaments of the leg, ankle, and foot found varying results depending on the specific condition ². 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 all ³. 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 activities ⁴. 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 advice ⁵. 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

Treatment for plantar fasciitis targets the band of tissue under the foot. The 2021 guide recommends stretching this band, taping, and advice on activities and footwear ⁵. The 2023 guidelines also recommend strengthening the foot and ankle and manual therapy to reduce pain and improve functional ability ⁶. This treatment plan is adjusted 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, among other things, 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 months ⁶. 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

Rehabilitation—treatment designed to help you regain your abilities—focuses on mobility, strength, balance, and the movements involved in your daily activities. It also aims to reduce the risk of new sprains, known as recurrences. Seven studies show that exercise-based rehabilitation reduces recurrences over a period of seven to twelve months compared to standard care ⁷. 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 provide an overall picture. The 2017 synthesis reports strong evidence in favor of early resumption of movement after a recent sprain ⁸. 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. ⁹

After a sprain, limit activities that cause pain and gradually resume weight-bearing as your ankle allows. A brace, a support worn around the ankle, or a support tape may help. For a severe sprain, brief immobilization may be necessary. The 2018 guidelines primarily recommend support combined with exercises—with supervision as needed—to restore ankle stability during activities. ¹⁰ Cold can provide relief. Wrap it in a towel to protect the skin. A support bandage and keeping the foot elevated can help limit swelling. ¹¹

The 2021 guidelines recommend protecting the ankle, gradually resuming weight-bearing, and following a structured exercise program ¹². 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 exercises ¹⁶. 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 heel ¹⁷. The 2024 guidelines recommend at least three sessions per week, with the highest intensity 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 tendon ¹⁸. Among the comparisons of exercise programs, none clearly outperforms the others in terms of pain relief or functional activity. 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 back toward the tibia ¹⁹. This consensus reflects the judgment of 17 experts; it does not prove that any one 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 need to resume.

Progress in Achilles tendon healing is measured by pain levels and the activities you are able to perform. A review tracks the progress of 31 groups of patients over a period ranging from two weeks to six months ²⁰. Pain and functional ability begin to 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

The connection between Lenoir's spine and pain is explained in our guide on the causes of foot and ankle 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.

Prefabricated and custom orthotics can complement the treatment of plantar fasciitis; custom orthotics have not been shown to be generally superior ²¹. In a trial involving 135 people, both types produced similar results ²¹. Compared to a thin, flexible insole used as a control, they slightly improved functional outcomes 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.

Surgery may be considered for persistent pain despite adherence to a non-surgical treatment plan. It can improve symptoms, but it also carries risks, including persistent pain or nerve damage. The surgeon will explain the proposed procedure in detail; removal of a bone spur is not always performed. ²²

The results of the procedure depend, in particular, on the condition being treated and the chosen approach. The decision to undergo surgery is made in consultation with the specialist after weighing the treatments already tried against the expected outcomes.

Shin splints

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.

After confirming the diagnosis, you should reduce activities that cause pain and then gradually resume physical activity. Low-impact activities, such as cycling or swimming, can help you stay in shape if you can tolerate them. Calf and foot exercises should be adapted to the specific difficulties you’re experiencing. ²³ The plan may include:

• 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 resume running gradually, without adhering to a specific percentage. An example of the 10% rule is provided below, in the “Progress Gradually” section.

Hallux valgus (bunion)

Non-surgical treatments may include the following options:

• These exercises strengthen the small muscles in the foot.
• The physical therapist 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.
• Protective pads: Cushions placed over the bump to reduce friction

Surgery may be considered when pain persists despite non-surgical treatment. A Cochrane review reports a possible benefit in terms of pain relief and functional ability compared to no treatment or non-surgical care, but this comparison is based on a single trial. Your doctor will help you weigh the different techniques, benefits, and risks. ²⁴

For hallux valgus, follow-up care focuses primarily on comfort in shoes, walking, and the activities that matter to you.

Metatarsalgia

Treatment for metatarsalgia can begin with comfortable shoes, a temporary reduction in impact, and a supportive insole. ²⁵ In a study without a comparison group, 25 of the 45 people who received insoles reported less pain and improved function at follow-up. This result is encouraging, but it does not allow us to attribute all of the improvement to the insoles. ²⁶ Another study, conducted on ten people, shows that the position of the pad alters pressure under the forefoot. This pressure measurement does not directly indicate pain relief. ²⁷

Physical therapy can be effective in several ways:

• Appropriate footwear: Cushioned insoles, wide toe box
• 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

For Morton's neuroma, several non-surgical treatment options can be discussed. Changing shoes and using insoles are initial non-surgical treatment options ²⁸. A shoe with a wide toe box and a low heel provides more room for 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 whether to continue these treatments.

A review reports improvements in pain for some people. It also discusses less convincing results after about four and a half months of treatment or for certain neuromas larger than 5 to 6 mm. These observations do not set a time limit for treatment or require surgery based on size. ²⁸ A 2025 clinical review also recommends starting with non-surgical treatment for Morton’s neuroma, plantar fasciitis, and Achilles tendinopathy. ²⁹

Physical therapy treatments take many forms:

• The physical therapist mobilizes the joints near the base of the toes.
• You should temporarily adjust any activities that make the pain worse.
• Wide-toed shoes: Reduce compression on the nerve

A review also reports favorable results from mobilization and manipulation techniques for pain, compared to a control treatment ³⁰. However, there is little evidence supporting the use of these therapist-administered movements for Morton’s neuroma; no single treatment stands out as clearly effective.

Another non-surgical option can be discussed:

• Corticosteroid injections: These anti-inflammatory medications can be injected along with a substance that temporarily numbs the area, called a local anesthetic. A Cochrane review found little or no difference in pain and activity levels after three to six months, compared with the local anesthetic alone. The certainty of this finding is low. Thinning of the skin or fatty tissue may occur. However, guiding the injection with ultrasound—which provides an image of the nerve—likely improves pain and functional activity more at six months than an injection without such guidance. ³¹

Stress fracture

Physical therapy can support a return to activities; medical evaluation and bone health factors remain important.

Treatment depends on the location:

• Fractures with a lower risk of poor healing, such as those in the middle of the second, third, or fourth metatarsals:

  Low-risk fractures require reducing physical activity and, in some cases, wearing 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 sufficient ³².

• Fractures with a higher risk of poor healing, particularly those involving the navicular bone (a bone in the midfoot), the base of the fifth metatarsal on the little toe side, or the small bones located under the big toe, known as sesamoids:

  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 union ³². 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.

A return to running is planned once healing and walking allow it. The healthcare professional monitors pain, conducts necessary tests, and assesses exercise tolerance. There is no single progression plan that works for all fractures. ^{33, 34}

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 plan ³⁵. 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 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.

The physical therapist selects exercises based on the movements you find difficult, your health, and your activities. Follow-up visits monitor tangible changes: walking distance, ease when using stairs, strength, or your ability to return to sports.

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 conditions ³⁶. 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 pain ³⁷. 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 moves a joint to improve its range of motion and reduce pain. The 2021 Ankle Guide recommends these techniques along with exercises ¹². The physical therapist compares your pain and range of motion at the beginning and end of the session.
• Soft-tissue mobilization: The physical therapist applies pressure or performs gliding movements on the muscles and the surrounding tissues.

Following a recent sprain, a review of three trials involving a total of 180 people reports benefits from treatment combining exercises and manual techniques ⁴. 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 the use of ice in combination with exercises or on the best way to apply it ³⁸. Wrap the ice in a cloth and limit application to 20 minutes. After a new sprain, avoid heat during the first few days ³⁹. 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. ⁴⁰

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 insufficient ⁵. 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 fascia ⁴¹. In a review of ten trials, relief typically lasts four to twelve weeks ⁴¹. 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 injection ⁴². 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 device ⁴³. 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 months ³⁹. 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 step ⁵. 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 weeks ²⁰. 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 longer ³³. The doctor confirms the progress and gives the okay to resume activities. 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 everyone ⁴⁴. 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 allowed according to agreed-upon guidelines; how the pain evolves after the session and the following day will then guide any adjustments ¹⁹.

If you suspect a fracture or are experiencing an urgent symptom, have your foot examined before trying them on.

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. Point your foot, then bring your toes toward you.

Stand facing a wall with your hands resting on it. Step one leg back, keeping that knee straight and the heel on the floor. 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. 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.

Another example of strengthening: walk on your toes, then on your heels.

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. 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. Pull your toes toward your shin until you feel a stretch under your foot. The physical therapist adjusts the duration ⁶.

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 sprain⁸, ⁷}. 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

The popular rule of limiting weekly mileage 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. ⁴⁵ The rule was tested among 532 beginner runners ⁴⁶. 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 to 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. Include recovery days.

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.
• Insoles chosen based on comfort and needs, not just on the shape of the foot
• Comfortable sole for physical activity; cushioning does not guarantee injury prevention
• 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 medical evaluation. Seek medical attention promptly if pain worsens despite treatment, if numbness spreads, or if strength decreases. Certain signs require urgent evaluation. ^{47, 25, 48}

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. These symptoms do not allow you to diagnose yourself. ^{47, 25}

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 weeks ⁴¹. Complications are rare and should be weighed against the expected benefit. The trials focus on a specific diagnosis 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 recovery depending on the procedure and the surgeon’s instructions. Following surgery for an ankle fracture, a 2015 review reported that active exercises accelerated a return to work and daily activities ⁴⁹. 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 permitted ³⁵. Check with your insurance provider regarding reimbursement terms.

However, some insurance companies require a prescription to reimburse medical expenses. ³⁵

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

1. Chapter 4: Searching for and selecting studies | Cochrane.↩ Back to text
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 text
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