Foot and ankle pain: Complete Guide

Pain in the foot or ankle can limit walking, sports, and daily activities. This guide outlines nine possible conditions, their symptoms, and their treatments. Treatment depends on the cause and severity of the pain. Physical therapy can relieve many of these conditions and help you resume your activities. To learn more about this field, check out our comprehensive guide to physical therapy and its therapeutic approaches.

What Causes Foot and Ankle Pain?

Foot and ankle pain can result from an injury, repetitive strain, a joint problem, or nerve irritation. An evaluation is conducted to determine the cause and identify the appropriate treatment. To learn about the structures of the foot, visit our page on foot anatomy.

The foot consists of bones, joints that allow them to move, muscles, tendons, and ligaments. Tendons connect muscles to bones. Ligaments connect bones to one another and help stabilize the joints.^{1, 2}

Your feet support your weight when you are standing. They also absorb the forces generated by walking, running, and jumping. The intensity and frequency of these forces vary depending on the activity, speed, and terrain. This amount of force is called the load on the foot.

Depending on the diagnosis, the items to be examined may include:

• Change in physical activity: increasing the duration, intensity, or frequency of exercise, especially if symptoms appear after this change.

• Injury: sprain, fracture, or blow to the foot.

• Foot shape and movement: factors to examine during the activity that causes pain, without attributing the cause of the pain to shape alone.

• Uncomfortable shoes: shoes that are too tight, high heels, or worn-out soles that make your symptoms worse.

• Joint or tendon problems: osteoarthritis, which affects the tissues of a joint, or tendinopathy, a painful condition affecting a tendon.

• Nerve problem: pressure or irritation that can cause pain, tingling, or a loss of sensation.

The forefoot, near the toes, is a common site of pain. A review compiled studies of adults aged 45 and older. It estimates that frequent pain affects the foot in about 24% of these adults and the ankle in about 15%. The toes and the forefoot were the most commonly affected sites.³ Calf pain typically occurs in the back of the leg, between the knee and the ankle. Our guide to calf pain explains its causes and treatments.

What is plantar fasciitis and how does it manifest?

Plantar fasciitis is a condition affecting the tissue under the foot that causes pain under the heel, often when taking the first steps in the morning or after resting. This tissue, called the plantar fascia, connects the heel to the forefoot and supports the arch of the foot.⁴ Our page on plantar fasciitis and Lenoir’s spur explains possible treatments.

Plantar fasciitis is a possible cause of heel pain. A physical examination can help distinguish it from, among other things, a nerve problem or a stress fracture—a small crack caused by repetitive strain.⁴

How can you recognize plantar fasciitis?

The pain often occurs under the heel, near where the fascia attaches. Possible landmarks include:

• Severe morning pain: The first few steps after waking up can be the most painful.

• Pain After Inactivity: Getting up after sitting for a long time causes pain

• Improvement at the start of walking: the pain may subside after a few minutes, then return with prolonged exertion.

• Worsening at the End of the Day: After a lot of walking or standing

The plantar fascia helps support the arch of the foot and transmit forces during walking. In plantar fasciitis, its fibers may undergo changes, and signs of inflammation may also be present. The term “fasciitis” alone does not fully capture all the changes in the tissue.⁴

Who is at risk for plantar fasciitis?

Plantar fasciitis is associated with limited ankle mobility, running, and long periods of standing at work. A high body weight relative to height is also associated with this condition in studies of non-athletic individuals. These factors help guide the evaluation; none alone is sufficient to confirm the diagnosis.⁴

What is the treatment for plantar fasciitis?

Non-surgical treatments typically combine exercises, activity advice, and, if necessary, manual techniques. The 2023 practice guidelines recommend stretching the plantar fascia and calf to reduce pain. They also recommend resistance exercises for the muscles of the foot and ankle.⁴

Options may include:

• Stretching Exercises: Calf and plantar fascia stretches

• Gradual strengthening: resistance exercises for the muscles of the foot and ankle, with an appropriate level of difficulty.

• Activity Modification: Temporary reduction of aggravating activities

• Appropriate shoes : chaussures confortables; une semelle de soutien peut compléter les autres soins si elle vous aide.

• Manual therapy: joint movements performed by the therapist and techniques applied to the muscles to reduce pain and improve range of motion.

If your heel pain persists, a physical therapy evaluation can help determine your needs.

What is an ankle sprain and how is it treated?

An ankle sprain is a stretching or tearing of the ligaments; treatment involves protecting the ankle and gradually restoring movement, strength, and balance. The severity of the injury determines the level of support needed.² Our article “How to Manage My Ankle Sprain” details these steps.

A lateral ankle sprain affects the ligaments on the outer sideof the ankle; an examination is used to assess stability, gait, and the need for protection.

How does an ankle sprain happen?

A lateral sprain can occur when the foot rolls inward and overstretches the ligaments on the outer side. This movement is called inversion.^{1, 2} In everyday language, this is referred to as “spraining your ankle.”

Typical circumstances include:

• Walking on an uneven surface

• Landing awkwardly after a jump

• Changing direction quickly in a sport

• Wearing unstable shoes (high heels)

• Tripping while going down stairs

What are the different grades of sprains?

Grades describe the severity of the ligament injury. Grade 1 corresponds to a sprain with small tears. Grade 2 corresponds to a partial tear. Grade 3 corresponds to a complete tear. The healthcare professional interprets these grades based on pain, swelling, walking ability, and ankle stability.²

How to treat an ankle sprain?

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.⁵ Cold can provide relief. Wrap the ice in a towel to protect the skin. A support bandage and keeping the foot elevated can help limit swelling.²

After the protection phase, we move on to mobility exercises, light strength training, and balance exercises, as long as the pain allows.

Back to the activity:

• Gradual strengthening

• Exercises that mimic useful movements, such as climbing a step or changing direction

• Gradual return to sport

After a sprain, some people continue to experience pain or a feeling that their ankle is giving way. This condition is referred to as chronic instability when the problem persists. Balance and movement control exercises, as well as ankle braces, help prevent another sprain.⁶ Our sports injury program can support your gradual return to activities.

What is Achilles tendinopathy, and what factors can contribute to it?

Achilles tendinopathy is a painful condition affecting the tendon behind the ankle, which can be caused by changes in training, previous injuries, or certain health issues. The Achilles tendon connects the calf muscles to the heel. It transmits the force generated by these muscles during walking, running, and jumping.⁷ Our guide to Achilles tendinopathy explains the exercises.

The location of Achilles tendon pain—at the point where the tendon attaches to the heel or a few centimeters higher—affects the range of motion during an exercise, known as amplitude. The term “tendinopathy” avoids the assumption that all tendon pain is caused solely by inflammation.^{8, 7}

How to recognize Achilles tendinopathy?

Possible reference points include:

• Pain at the back of the heel or a few centimeters higher

• Morning stiffness in the tendon

• Pain at the start of activity that subsides and then returns

• Visible thickening of the tendon

• Sensitivity to touch

There are two main types:

• Medial portion tendinopathy: Pain located 2 to 6 cm above the heel.

• Insertional tendinopathy: Pain directly at the point where the tendon attaches to the calcaneus (heel bone). A bony growth visible on an X-ray is not sufficient to explain the pain.

What are the causes of Achilles tendinopathy?

Achilles tendinopathy can develop when several factors alter the tendon’s ability to withstand stress. Changes in training, past injuries, certain medications, and overall health can all play a role. The 2024 guide notes that the exact causes remain unclear.⁷

Factors to consider in your situation include:

• Rapid increase in training intensity or volume

• Calf strength and ankle mobility, which help in adapting the exercises

• Shoe Comfort and Recent Design Changes

• Changes in terrain, slope, or session frequency

• Age, previous injuries, medications, and health conditions that may affect exercise tolerance

How to treat Achilles tendinopathy?

Exercises that gradually increase the load on the tendon are a recommended initial treatment for tendinopathy of the midportion of the tendon. They can reduce pain and improve the ability to walk or participate in sports.⁷ A review of 21 trials involving 994 participants reports a pain-relieving benefit for eccentric exercises—performed by slowing the heel’s descent—compared to certain passive physical therapies. It does not show a clear pain-relieving benefit compared to other exercises. Its findings regarding the ability to perform activities vary widely across studies.⁹ A step-down below the level of a step may be appropriate for the midfoot. This range of motion should be adjusted when pain is located at the heel attachment site.

The program adjusts the number of repetitions, the difficulty, and the range of motion. It may include:

• Progressive-load exercises, with frequency and duration adjusted based on monitoring

• Reducing activities that worsen symptoms, while continuing to engage in tolerated activities when the diagnosis allows

• Gradual load progression

• Work on calf mobility

Recovery can take several months. Progress is not always steady: the program is adjusted based on pain levels, walking ability, and the level of exertion the patient can tolerate.⁷

What is a heel spur and does it really cause pain?

A Lenoir spur (or heel spur) is a bony growth that forms on the calcaneus, the heel bone. A spur may be present with or without pain; the imaging findings must be interpreted in conjunction with the symptoms and physical examination.

Is a heel spur the cause of my pain?

The relationship between Lenoir's spine and pain is complex. The available observations suggest that Lenoir's spine should be interpreted with caution:

• Lenoir's spine may be present in people who do not experience pain.

• The size of the thorn alone does not explain the intensity of the pain.

• The spine alone is not sufficient to identify the structure contributing to the symptoms.

Lenoir's spur may accompany plantar fasciitis, but it can also be present without causing pain. An imaging study alone does not determine the treatment; symptoms and a physical examination of the foot remain essential.¹⁰

How are heel spurs treated?

Treatment focuses on the source of pain identified during the examination. When plantar fasciitis is the cause of the pain, exercises, adjustments to daily activities, and shoe inserts can help. It is generally not necessary to remove the bone spur to treat this pain.^{4, 10}

• Modifying aggravating activities

• Manual therapy

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 necessary.¹⁰

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.

What are shin splints (tibial periostitis) and why do they affect runners?

Tibial periostitis is exercise-induced pain along the inner edge of the tibia, the large bone in the leg, often associated with repetitive movements or an increase in training volume among runners. It can also affect dancers and other athletes.¹¹ Our article “Why Do I Keep Getting Injured While Running?” explains how to adjust the intensity of your workout.

The page on tibial periostitis explains how to evaluate pain that extends over several centimeters along the inner edge of the tibia. More localized pain may suggest another cause, such as a stress fracture, but is not sufficient to confirm it.¹²

What diagnoses should be considered when a patient presents with shin pain?

"Shin splints" is a common term for medial tibial stress syndrome. However, pain in the shin may have other causes that need to be distinguished:

• Medial tibial stress syndrome: the medical term for tibial periostitis, also known as “shin splints.” The pain typically extends along the inner edge of the tibia.

• Compartment syndrome: Excessive pressure builds up within a compartment containing muscles. The form that appears suddenly can damage muscles and nerves; it is a medical emergency. Another form occurs during exertion and usually subsides with rest.¹³

• Stress fracture of the tibia: a crack in the bone caused by repeated stress. Even before the crack forms, the bone may already be painful when under stress.

How to recognize shin splints?

Typical symptoms of Medial Tibial Stress Syndrome include:

• Pain along the inner edge of the shin bone (over several centimeters)

• Pain that appears during or after exercise

• Diffuse tenderness to the touch

• Improvement with rest, returns with activity

Signs that require urgent evaluation:

Consult immediately if you have:

• Sudden, very severe pain, or pain that worsens rapidly despite rest

• Significant leg swelling that increases rapidly

• Resting pain that becomes intense

• Numbness or weakness in the foot

These signs may indicate acute compartment syndrome. Do not wait until all of them are present to seek urgent evaluation. A very tight and stiff leg, a cold or pale foot, or severe pain when moving the toes may also accompany this medical emergency.^{13, 14}

How is shin splints treated?

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.¹¹ The plan may include:

• Load Reduction: Decrease training volume or intensity

• Shoes and Running: Try adjusting your shoes or running form if a particular shoe or running style makes your symptoms worse, and then see how that affects your comfort and activities.

• Progressive Strengthening: Exercises for calf and foot muscles

• Gradual return: Resume running gradually, without a sudden increase in mileage from one week to the next.

Periostitis can develop when training load, recovery, and other factors interact. The training load is adjusted based on the diagnosis, symptoms during and after activity, and the observed recovery.

Does physical therapy work for foot and ankle pain?

Physical therapy can reduce pain and improve walking after a sprain, plantar fasciitis, or Achilles tendinopathy. Treatment combines tailored exercises, advice, and, when appropriate, manual therapy.^{7, 6, 4}

After a sprain, exercises and ankle braces reduce the risk of re-injury. Exercises and manual therapy can also help relieve pain and improve function.⁶

For plantar fasciitis, stretching and manual therapy are among the recommended treatments. For the midportion of the Achilles tendon, several forms of progressive strengthening can reduce pain and improve functional ability; heel raises are not the only option.^{4, 7}

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.

Recovery also depends on the severity of the problem. A mild sprain may allow for improvement within a few weeks; a more serious injury or a tendon that has been painful for a long time may take several months^{.2, 7} A suspected fracture requires a medical evaluation first and, if necessary, protection of the bone.¹⁵

An assessment is used to clarify the diagnosis, the risks, and the activities affected.

What is hallux valgus (bunion) and can it be treated without surgery?

Hallux valgus is a deviation of the big toe toward the other toes; non-surgical treatments can reduce pain and improve comfort when wearing shoes. This deviation often forms a bump called a “bunion.” Wide-toe shoes, bunion guards, certain exercises, and supportive insoles are options to discuss.^{16, 17} Their long-term effect on the deformity remains uncertain.

Our guide tohallux valgus details the associated factors, symptoms, and treatment options to discuss based on comfort and function.

Why does hallux valgus develop?

Several factors can contribute to hallux valgus, including bone structure, heredity, and the flexibility of the tissues that stabilize the big toe. Footwear can also affect pressure distribution and symptoms.¹⁸ The following factors may be relevant:

• Heredity: Bone structure and tissue flexibility can run in families and contribute to the deviation. These are just a few of the possible factors.¹⁸

• Female population: A review of 76 studies, involving nearly 497,000 participants, estimates that approximately 30% of women and 13% of men have hallux valgus. These percentages are based on a pooled analysis of the studies; they vary by population and increase with age.¹⁹

• Tight Shoes: Tight shoes can increase pressure and discomfort on the bunion

• Flat feet: The arch of the foot is low. This condition may or may not be accompanied by hallux valgus; it alone is not enough to explain the pain.

• General health: A factor to consider when tailoring care, though it does not, on its own, explain the deformity.

What are the symptoms of a bunion?

Symptoms vary depending on severity:

• A visible bump on the side of the foot

• Pain on the bump, especially when wearing shoes

• Redness and inflammation

• Corns or calluses: areas where the skin becomes thicker

• Difficulty finding comfortable shoes

• Overlapping toes in advanced cases

How to treat a bunion without surgery?

Non-surgical treatments are designed to reduce pain and make it easier for you to perform your daily activities. Certain exercises, combined with a support strap or a brace, can also modestly reduce the angle of deviation of the big toe.¹⁷ A reduction in the angle does not guarantee complete or lasting correction. The review of 11 trials involving 401 participants focused on mild to moderate deformities; the authors call for higher-quality and larger studies. Surgery remains an option if pain persists despite non-surgical treatments.¹⁶

• Appropriate footwear: Wide toe box, no high heels

• Toe separators: Separate the big toe from the others

• Protective pads: Cushions placed over the bump to reduce friction

• Exercises: Strengthening the small muscles on the inside of the foot.

• Orthotics: insoles or supports designed to redistribute pressure on the foot.

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 with no treatment or non-surgical care, but this comparison is based on a single trial. Your doctor will help you weigh the different treatment options, benefits, and risks.¹⁶

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

You can schedule a physical therapy appointment without a doctor's prescription. However, some insurance companies require a prescription to cover the cost of treatment.²⁰

What is metatarsalgia and how can it be relieved?

Metatarsalgia is pain under the forefoot, near the base of the toes, which can be relieved by wearing appropriate shoes, using shoe inserts, and reducing impact. This term describes the painful area; the specific cause determines the treatment.²¹ The metatarsals are the long bones behind the toes. Their rounded ends, called metatarsal heads, provide support under the forefoot. Our article on running shoes can help you choose a comfortable pair.

The evaluation of metatarsalgia focuses in particular on identifying problems with the joints, nerves, skin, or bones. A stress fracture requires different treatment than pain caused by shoes that are too tight.^{21, 12}

What are the causes of metatarsalgia?

Pain in the forefoot can have several causes. Factors to consider include:

• Weight and pressure distribution: The weight borne by the foot can contribute to pressure, along with activity level, walking speed, and footwear.

• Inappropriate shoes: High heels, hard soles

• High arches: A pronounced arch under the foot can redistribute pressure, though this alone is not enough to confirm the cause of the pain.

• Hallux valgus: May be associated with a different distribution of weight-bearing, without establishing the cause of the pain

• High-impact activities: Running, jumping, dancing

• Pad under the foot: The thickness of the tissue that cushions the foot can change with age; the exam determines whether this contributes to the symptoms.

How to recognize metatarsalgia?

Typical symptoms include:

• Pain under the ball of your foot, as if you're walking on pebbles

• Burning sensation or sharp pain

• Worsens when walking, especially barefoot

• Corns or calluses under the ball of your foot

• Improves with rest

What is the treatment for metatarsalgia?

Treatment for metatarsalgia can begin with comfortable shoes, temporarily reducing impact, and a supportive insole.²¹ 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.²² Another study, conducted on ten people, shows that the position of the cushion alters pressure under the forefoot. This pressure measurement does not directly indicate pain relief.²³

• Appropriate footwear: Cushioned insoles, wide toe box

• Support pads or insoles: Their shape and position can be adjusted to improve comfort under the forefoot.

• Exercises: Toe and calf stretches, foot strengthening

• Activity modification: Reduce impact activities

• General Health and Weight: To be discussed only if the person wishes and if it is relevant to the overall profile

What is Morton's neuroma and how can you recognize it?

Morton's neuroma is a painful thickening around a nerve that runs between the bones of the forefoot. It can cause a burning or tingling sensation in the toes. It is not a true tumor. One review reports a ratio of about five women to one man and an average age of about 50 at the time of surgery, based on the populations studied.²⁴

What are the symptoms of Morton's neuroma?

Typical symptoms include:

• Sharp or burning pain between the toes

• Feeling like you're walking on a bump or a pebble

• Numbness or tingling in the adjacent toes

• Worsens with tight shoes

• Relief when removing shoes and massaging the foot

The pain may feel like an electric shock and spread to the neighboring toes.

What are the treatment options?

Wide-toe shoes and supportive insoles are non-surgical options for Morton’s neuroma. 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 treatment deadline or require surgery based on size.²⁴ A 2025 clinical review also recommends starting with non-surgical care for Morton’s neuroma, plantar fasciitis, and Achilles tendinopathy.²⁵

• Wide-toed shoes: Reduce compression on the nerve

• Metatarsal support: Try it out to adjust pressure and comfort in the forefoot

• 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 functional ability 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 a visual image of the nerve—likely improves pain and functional ability more significantly at six months than an injection without this guidance.²⁶

• Adjusting activities: Temporarily reduce activities that increase pain, then resume them as tolerated.

If symptoms persist, a doctor can help you weigh your options, their benefits, their risks, and the treatments you have already tried.

What is a foot stress fracture and who is at risk?

A stress fracture of the foot is a small crack in the bone caused by repeated stress, often resulting from an increase in training intensity or bone fragility. It can affect athletes, but it can also occur during everyday activities if the bones are fragile.¹⁵ Our article “How to Start Running Without Getting Injured ” provides guidelines for progressing.

Stress fractures of the metatarsals require treatment tailored to the affected bone and its ability to heal. The American Academy of Orthopaedic Surgeons’ page on stress fractures of the foot and ankle explains these differences.

How does a stress fracture develop?

Bone continuously renews part of its tissue. Repeated stress can cause small lesions to form faster than the bone can repair them. This reaction can progress to a fracture. Fragile bones can also fracture under stresses that are normally well tolerated.^{15, 12}

Topics discussed during the evaluation may include:

• Rapid increase in training volume

• Anterior Stress Fracture and Conditions for Healing

• Insufficient dietary intake to meet the demands of physical activity and recovery

• Weaker bones, such as those affected by osteoporosis

• An eating disorder or a prolonged absence of menstrual periods, which require medical evaluation

• Foot shape alone is not enough to determine an individual's risk

• Changes in footwear or playing surface should be considered in conjunction with changes in training

For runners, the professional assesses distance, intensity, recent changes, and recovery periods. He or she may also recommend a medical or nutritional evaluation if a hormonal, dietary, or bone-related issue is suspected.^{15, 12}

A review compared runners with and without a history of stress fractures. There was no clear difference in the vertical force exerted against the ground between the groups. However, the rate at which this force was applied was higher in the group with a history of fractures. This association does not prove the cause of a fracture in an individual.²⁷

One study directly measured deformations of the tibia in a single man. Certain shear stresses between parts of the bone were higher during on-the-spot jumps and stair jumps than during running up stairs. This experiment does not allow for a comparison of the risk of injury across all these activities in the general population.²⁸

How to recognize a stress fracture?

A stress fracture can cause localized pain in a bone, which worsens with weight-bearing. The pain may develop gradually and then persist after activity or at rest. The sequence and intensity of symptoms vary; no single sign confirms the diagnosis.^{15, 12}

• At first, sometimes: pain during activity.

• As the condition progresses: pain that may become more intense and persist after physical activity.

• Symptoms to have evaluated: pain at rest or localized tenderness over the bone—don’t wait until the condition has progressed to an advanced stage.

A stress fracture often occurs without a fall or impact. Seek medical attention promptly if you suspect one, and stop running or jumping until you’ve been evaluated.¹⁵

Significant pain when you put weight on your foot requires an evaluation. Tests using an ultrasound machine or the vibrations of a tuning fork—a small metal instrument—are not sufficient to confirm or rule out a stress fracture. The healthcare professional will determine which imaging tests are necessary.²⁹

A normal X-ray at the outset does not rule out a stress fracture. According to a review, X-rays detected only 12 to 56 percent of existing fractures, depending on the study. Magnetic resonance imaging (MRI) produces detailed images of the bone and can detect a lesion earlier when doubt persists.³⁰

What is the treatment for a stress fracture?

The treatment protects the bone while it heals and then gradually reintroduces weight-bearing. The location and severity of the fracture determine whether crutches, a boot, immobilization, or surgery are needed.^{15, 12}

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

• Reduction or temporary suspension of activities that place a burden on the site, based on clinical judgment

• Supportive shoe or walking boot

• Common stress fractures typically heal within six to eight weeks, though healing may take longer in some cases, and a return to sports is determined on a case-by-case basis

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:

• Stricter immobilization

• Longer recovery

• Close monitoring

A return to running is planned once healing and walking allow it. The healthcare professional monitors pain, conducts necessary tests, and assesses exercise tolerance. A single progression plan does not apply to all fractures.^{15, 12}

When should I seek help for my foot or ankle pain?

You should seek urgent care if the pain in your foot or ankle is very severe, if you are unable to walk, or if your foot has changed shape, even without a known injury. Other signs requiring urgent care are detailed below.^{21, 31} For milder pain that recurs and interferes with your activities, a physical therapy evaluation may help.

Pain in the foot or ankle isn't always an emergency. However, certain symptoms require prompt evaluation.

Seek immediate medical attention if you experience any of the following symptoms:

• Your foot or ankle has changed shape, even without a known injury

• You are unable to walk, even if you have no known injury, or the pain is very severe

• Significant swelling increases rapidly, especially if the leg becomes very tight or stiff

• Leg pain appears suddenly and becomes very severe, or worsens despite rest

• Your foot is warm, swollen, and painful, or you have foot pain accompanied by a fever or chills

Also seek urgent care if an injury is accompanied by a cracking or grinding sound, or if the pain causes dizziness, nausea, or the feeling that you are about to lose consciousness.^{21, 31} A cold or pale foot, or one that feels numb or weak, may also require urgent evaluation, especially if accompanied by severe leg pain.¹⁴

Pain that persists, recurs, or increasingly limits your activities is also a reason to see a doctor. If you have diabetes, seek medical advice promptly if you experience new foot pain.²¹

Consult a professional within the next few days if you have:

• Pain that wakes you up at night

• Persistent numbness or tingling, without the urgent symptoms described above

• Difficulty walking normally, while still being able to walk

• Significant bruise with no blow or injury to account for it

Seek non-urgent consultation if you have:

• Recurrent mild pain that affects your activities

• Questions about injury prevention

• Need advice on footwear or orthotics

How to prevent foot and ankle pain?

These options can help manage certain factors, though they do not guarantee prevention:

Choose the Right Shoes

• Toe box wide enough for your 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

• Replace your running shoes regularly, once the cushioning has worn out.

Progress Gradually

• Gradually increase the duration or intensity of your workout as your recovery allows.

• Keep track of your pain, the activities you can do, and your recovery; adjust your routine accordingly.

• Include recovery days

Strengthen your feet

Exercises can strengthen the muscles of the foot and calf or improve balance. The following examples can be adapted to your specific condition and abilities. If you suspect a fracture or are experiencing an urgent symptom, have your foot evaluated before trying these exercises.

• Toe curls (picking up a towel with your toes)

• Calf raises (standing on your tiptoes)

• Walking on your toes, then on your heels

• Single-leg balance exercises

Take care of your overall health

Nutrition, bone health, and recovery can all be part of your plan. If your weight is contributing to difficulties with weight-bearing, you can discuss this with your healthcare professional, keeping your goals in mind. A diet that doesn’t provide enough nutrition for your activities also warrants special attention.¹²

What is the role of physiotherapy in treating foot and ankle pain?

Physical therapy combines assessment, exercises, advice, and certain manual techniques to help you perform daily activities despite a foot or ankle problem. Your physical therapist can:

• Assess your symptoms and mobility, and then refer you to a doctor if necessary

• Create a personalized exercise program.

• Test a manual technique when a relevant limitation is present, and then verify its effect

• Advise on footwear and orthotics

• Guide your gradual return to activity

Treatment approaches vary depending on the condition:

• Manual therapy: joint movements and muscle techniques performed by the therapist.

• Therapeutic exercises: strengthening, stretching, and exercises for balance or movement control.

• Tips: Understand your problem and learn how to adjust your activities or exercises.

• Comfort: Cold, wrapped in a towel if that provides relief, or gentle heat for relaxation. These methods complement the exercises and advice.

If your foot or ankle pain is affecting your daily activities, our physical therapists can assess your condition and discuss treatment options.

References

Links open in a new tab.

1. Fraser JJ, Feger MA, Hertel J. MIDFOOT AND FOREFOOT INVOLVEMENT IN LATERAL ANKLE SPRAINS AND CHRONIC ANKLE INSTABILITY. PART 1: ANATOMY AND BIOMECHANICS. Int J Sports Phys Ther. 2016;11(6):992-1005. (Back to sections: 1, 2)
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