Conditions We Treat
Ankle & Foot Pain
At a glance
Foot and ankle pain often comes from plantar fasciitis, Achilles tendinopathy or an ankle sprain. Shockwave therapy for plantar fasciitis and progressive loading programmes for Achilles tendinopathy are both supported by meta-analyses, and the Ottawa ankle rules help decide which ankle injuries need an X-ray. We assess the knee, hip and lower back as well as the foot, so anything contributing from higher up is part of the plan.
Your feet and ankles bear the weight of every step you take, so when something goes wrong, it's hard to ignore. Ankle sprains are one of the most common musculoskeletal injuries (Doherty et al., 2014), and plantar fasciitis accounts for over 1 million doctor visits a year in the US alone (Rhim et al., 2021). Whether your pain came on suddenly from a twist or has built up gradually, these are problems we treat regularly.
Ankle sprains typically involve the lateral (outer) ligaments and occur when the foot rolls inward. Indoor and court sports carry the highest rate of ankle sprains (Doherty et al., 2014). Many people assume a sprain will sort itself out, but repeat sprains and ongoing instability are common: one prospective study found 40% of people had chronic ankle instability a year after their first sprain (Herzog et al., 2019). Early mobilisation with progressive balance and strengthening work forms the core of our rehab. Pain usually drops quickly over the first two weeks (van Rijn et al., 2008), but a previous sprain is linked to roughly 3.5 times the risk of another (Herzog et al., 2019). Most sprains do not need an X-ray, and the Ottawa ankle rules identify the ones that do (Halabchi and Hassabi, 2020).
Plantar fasciitis is a frequent cause of the heel pain we see. The plantar fascia, a thick band of tissue running along the sole of the foot, is considered to undergo degenerative change rather than simple inflammation, and the pain sits under the inner heel, typically worse with weight-bearing and after rest, such as the first steps in the morning. Higher body mass index is the most consistent risk factor, and the condition affects up to 17.4% of runners (Rhim et al., 2021). Across the systematic reviews they summarised, stretching and manual therapy were generally associated with better pain and function, and manual therapy combined with stretching or strengthening was linked to greater improvements in function (Rhim et al., 2021). Shockwave therapy adds another option: a meta-analysis of 11 randomised trials found it reduced pain intensity (Lippi et al., 2024).
Achilles tendinopathy is another common presentation, in active and less active people alike (Murphy et al., 2018). The tendon becomes painful and stiff, either in its middle portion or where it joins the heel. Progressive loading programmes are well supported: a longitudinal meta-analysis of 31 patient groups found pain and function improved from as early as 2 weeks, with gains appearing to peak around 12 weeks (Murphy et al., 2018). We combine loading with calf and ankle mobilisation and a graduated return-to-activity plan.
We always assess the foot and ankle as part of the whole lower limb. That means checking the knee, hip and lower back too and including anything we find there in your treatment plan.
In pain now? Same-day appointments available at our Sandton rooms.
Book OnlineCommon symptoms of ankle & foot pain
- Sharp heel pain with the first steps in the morning
- Swelling and bruising after twisting your ankle
- Pain at the back of the heel or Achilles tendon
- Ankle giving way or feeling unstable
- Pain in the arch of the foot after standing or walking
- Stiffness in the ankle that limits movement
- Pain that increases with running or jumping
- Difficulty walking up or down stairs
- Tenderness along the sole of the foot
- Recurrent ankle sprains or a sense that the ankle is weak
Our approach combines hands-on treatment with structured rehabilitation. For ankle sprains, plantar fasciitis and Achilles tendon problems, that means mobilisation and soft tissue work alongside progressive loading exercises tailored to your activity level.
Located on Rivonia Road in Morningside, we serve patients from Sandton, Bryanston, Fourways, Randburg and surrounding areas. Runners can also take our 60-second injury risk screen to identify what might be driving their foot or ankle problems.
Book an appointment at our Sandton practice and let us help you get back on your feet.
Ready to get out of pain?
Same-day appointments available at our Sandton rooms.
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Frequently Asked Questions
Yes. Chiropractors are trained to assess and treat conditions of the ankle and foot including sprains, plantar fasciitis and Achilles tendinopathy. Treatment typically includes joint mobilisation, soft tissue therapy and progressive rehabilitation exercises.
Plantar fasciitis affects the thick band of tissue under the sole of the foot, and despite the name it is considered a degenerative condition rather than a simple inflammation. Higher body mass index is the most consistently identified risk factor, and weaker links have been found with prolonged standing and reduced ankle bend. It is common in runners. Pain sits under the inner heel and is typically worse with weight-bearing and after periods of rest, such as the first steps in the morning.
It depends on how much ligament damage there is. Pain usually eases quickly, and a review of 31 studies found a rapid drop in pain within the first two weeks. Getting back full strength, balance and confidence in the ankle takes longer, and a previous sprain is linked to roughly 3.5 times the risk of another, which is why we build balance and strength work into rehab rather than stopping when the pain settles.
Usually not. Most ankle sprains do not need an X-ray, and we use the Ottawa Ankle Rules, a validated clinical check, to identify the ones that do. If the rules point to a possible fracture, we refer you directly for an X-ray before starting treatment.
Achilles tendinopathy is a painful, stiff Achilles tendon, felt in the middle of the tendon or where it joins the heel. It is common in both active and less active people. Progressive loading programmes are well supported: a meta-analysis of 31 patient groups found pain and function improved from as early as 2 weeks, with gains appearing to peak around 12 weeks.
References
- Doherty C, Delahunt E, Caulfield B, et al. The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis. Sports Medicine. 2014;44(1):123-140.
- Rhim HC, Kwon J, Park J, Borg-Stein J, Tenforde AS. A systematic review of systematic reviews on the epidemiology, evaluation, and treatment of plantar fasciitis. Life (Basel). 2021;11(12):1287.
- Lippi L, Folli A, Moalli S, et al. Efficacy and tolerability of extracorporeal shock wave therapy in patients with plantar fasciopathy: a systematic review with meta-analysis and meta-regression. European Journal of Physical and Rehabilitation Medicine. 2024;60(5):832-846.
- Murphy M, Travers M, Gibson W, et al. Rate of improvement of pain and function in mid-portion Achilles tendinopathy with loading protocols: a systematic review and longitudinal meta-analysis. Sports Medicine. 2018;48(8):1875-1891.
- van Rijn RM, van Os AG, Bernsen RM, et al. What is the clinical course of acute ankle sprains? A systematic literature review. American Journal of Medicine. 2008;121(4):324-331.e6.
- Herzog MM, Kerr ZY, Marshall SW, Wikstrom EA. Epidemiology of ankle sprains and chronic ankle instability. Journal of Athletic Training. 2019;54(6):603-610.
- Halabchi F, Hassabi M. Acute ankle sprain in athletes: clinical aspects and algorithmic approach. World Journal of Orthopedics. 2020;11(12):534-558.