Ankle and Foot Pain: Causes, Symptoms and How Chiropractic Care May Help

This page covers ankle and foot pain. Almost everybody has twisted an ankle and most of the time the sprain settles in a short time. The ankle problems I see are different: when the ankle is still swollen and sore two months later, the ankle that has rolled over so often the patient has become aware of its weakness and the ankle that has not felt quite right after an injury years ago. Ankle pain doesn’t always get taken seriously enough because it gets dismissed as trivial.

This page covers ankle sprains and ligament injuries, ankles that give way and foot pain that turns out not to be coming from the foot at all but caused by something else. All other leg conditions are covered in my leg, knee, ankle and foot conditions page.

“Leslie identified the issue straightaway ”

“I went to see Leslie with an agonising persistent pain which was preventing me from walking unless I took strong pain killers. Leslie identified the issue straightaway and saved me from unnecessary X-rays and painkillers. His knowledge was second to none and really helped me understand what had caused the pain in the first place. Within a few weeks, the pain had subsided and I ran a half marathon!”

Christine T

What is an ankle sprain?

A sprain in the ankle means a ligament has been overstretched or partly torn. Ligaments are the short, tough bands which hold one bone to the next and the ankle has several. Most sprains happen when the foot rolls underneath you, stretching the ligaments on the outside of the ankle, which is why the pain and swelling usually sit just below and in front of the bony lump on the outer side of the ankle.

Sprains are graded by how much of the ligament has been damaged, from a mild overstretch to a complete tear. The grade of the injury matters the least. What matters more is whether the ankle has recovered its strength, movement and sense of position because if an ankle that has not recovered it tends to sprain again.

Referred foot pain means pain that is felt in the foot or ankle but caused by something elsewhere, most often referred from the lower back or along a nerve running down the leg.

What causes ankle pain

The commonest cause of ankle pain is a trip or fall over a kerb or uneven ground, a missed step or an awkward landing playing sport. Bournemouth’s terrain contributes to these hazards as we have the cliff paths, the beach and the uneven ground around the various chines all presenting potential trip and twist hazards for the ankle.

The second group is more interesting clinically: repetitive ankle sprains. After an injury the ankle may loose some of its ability to sense its own position, proprioception, due to damaged sensory receptors and the muscles that would correct a stumble then respond a fraction too slowly. The results in the ankle feeling unreliable on uneven ground and the ankle gives way without much major cause. Patients call it a weak or unstable ankle, which is a fair description this may also feel as a loss of confidence in the ankle.

Then there are ankles that ache with no injury at all: stiffness from an old fracture, pain following a change in activity or discomfort referred from higher up the body.

runner on the promenade at Bournemouth Beach

Explore our leg, knee, ankle and foot guides

Leg, knee, ankle or foot pain: the main guide

Heel, ankle and foot

Plantar fasciitis and heel pain: pain under the heel
Achilles tendinopathy: pain behind the heel, heel cord pain and tight calves
Ankle pain and referred foot pain: rolled ankles and ligament injuries (you are here)

Knee, thigh and calf

Related guides

When leg pain starts in the back

When leg pain starts in the hip or pelvis

Staying active

What ankle and referred foot pain feels like

A fresh ankle sprain hurts with immediate pain, swelling within a few hours and then bruising will appear a day or two later which often spreads into the foot and there will be difficulty putting weight onto the foot. Most people can walk on it, awkwardly, within a day or two.

An ankle with ongoing instability feels different. There is often less pain when resting it but the ankle feels unreliable in its strength. Patients tell me they avoid the uneven surfaces of beach or have stopped running on anything but level and solid pavements.

Referred pain is if your foot or ankle pain comes with pins and needles, numbness or a burning feeling which arrived without any injury. The pain travels rather than staying in one spot or comes with back or buttock symptoms meaning that the source may be higher up. Sciatica is the classic example of this; an irritated nerve in the lower back producing symptoms down into the foot.

patient clutching their ankle to show where her ankle and foot pain is felt

Ankle pain from a sprain or strain or referred pain into the ankle or foot.

How chiropractic may help

My first job is working out what is injured and whether the ankle is the source at all, which means examining the knee, hip and lower back too. Treating the area that hurts or the location of the pain is not the same as treating the cause.

Where the problem is a sprain or a stiff, unreliable ankle treatment usually combines hands-on work to restore movement at the ankle and the small joints of the foot, soft tissue treatment to the calf and a progressive exercise programme. The exercise part is vital. An overview of systematic reviews found strong evidence that exercise therapy reduces the risk of a further sprain and that bracing or taping also reduces reinjury, although the same review was clear that the quality of the underlying studies varied.[2]

Early management has moved on from the RICE advice, Rest, Ice, Compress and Elevate, most of us grew up with. The PEACE and LOVE framework favours protecting the joint briefly, then getting it moving and loading it early rather than resting it for weeks and questions the routine use of anti-inflammatories and ice on the grounds that they may interfere with normal healing.[3] European guidance takes a similar line, recommending functional treatment over immobilisation and noting that examining the ankle four to five days after the injury gives a more reliable picture of ligament damage than assessing it immediately.[4]

A straightforward sprain often responds within a few weeks. A long-standing unstable ankle takes longer. Every plan is built around the individual ankle.

When a podiatrist is the better person to see

I am a chiropractor, not a chiropodist or podiatrist and the two are frequently confused. If your problem lies in the structure of the foot itself, a podiatrist is usually the right person: bunions, a stiff or painful big toe, problems with the arches, anything involving the nails or skin and foot care for anyone with diabetes. Pain in the ball of the foot sits between the two professions. I would rather send you to the right person than treat something that I can not help with.

If pain in your ankle is getting in the way of things you would rather be doing, come and talk it through. I offer a free 15-minute consultation, you can come in for a short no-obligation chat with no examination or treatment.

Book a free consultation

Or call for a chat on 01202 937568

red flags:seek medical attention first

Most ankle pain is not a sign of anything dangerous, but a few situations need a medical opinion. If you cannot bear weight immediately after the injury or there is tenderness directly on the bone at the back edge of either ankle bone or the outer edge of the mid-foot, a fracture needs excluding. Those criteria come from the Ottawa ankle rules, whose pooled sensitivity across 27 studies and more than fifteen thousand patients was around 97.6 per cent, making it a reliable way of deciding who needs an X-ray.[1]

Get urgent medical advice for a calf or ankle that is swollen, hot and tender on one side only, particularly after surgery, illness or a long journey and for sudden pain at the back of the heel with a snap and an inability to push off. Any obvious deformity or an ankle you cannot move at all, should go to A&E. Progressive numbness or weakness in the foot, or a foot that drops when you walk, needs prompt assessment.

your first visit to Bournemouth Chiropractic

At your first chiropractic appointment I will take a full medical history of how the ankle injury happened and what has happened since, then I examine the ankle and foot along with the knee, hip and lower back. That includes specific ligament tests and where the injury is recent and fulfils the criteria for deciding whether an X-ray is needed. I will explain what I find and agree a plan with you.

Frequently Asked Questions

Can a chiropractor help with a sprained ankle?

Yes a chiropractor can help with a sprained ankle, for short-term management alongside rehabilitation. Hands-on treatment can help restore movement and reduce pain and the balance and strength programme is what lowers the risk of another sprain. If the injury needs an X-ray, I will send you for one.

Should I rest a sprained ankle or keep moving?

Protect and rest the sprained ankle for a day or two, then start moving and loading it as pain allows. Prolonged rest and lengthy immobilisation are no longer recommended for ordinary sprains, because the ankle recovers strength, movement and position sense through use.[1] Severe injuries are the exception and need assessing first.

Why does my ankle keep giving way?

If your ankle keeps giving way it is usually because the balance and reaction side of the ankle never recovered after an injury, rather than because the ligaments are permanently loose. Position sense and the speed of the muscles that protect the joint both drop after a sprain and do not come back on their own. A structured balance programme is the answer and it takes weeks of consistency .

Do I need a scan for pain in the middle of my foot?

You do not need a scan immediately for foot pain, not usually at first. Mid foot pain is generally assessed clinically and imaging is reserved for suspected fracture, pain that is not settling as expected or arthritis that needs confirming before a decision about footwear or surgery. Bone tenderness after an injury does warrant an X-ray.[2]

When should I go to A&E rather than book an appointment for a sprained ankle and foot pain?

Go to A&E if you cannot take four steps in a row after an injury, if the ankle looks deformed or if there is bone tenderness over either ankle bone or the mid foot bones. A hot, swollen foot with a fever or calf pain and breathlessness after time in a boot, also needs urgent medical attention rather than a chiropractic appointment.

Whatever is behind your ankle or foot pain, come and find out

Feet and ankles tend to get ignored until they don't feel right. An ankle rolled months ago that still feels unreliable on uneven ground or an ache through the middle of the foot that has crept in without any obvious cause, both leave people wondering whether this is now permanent. At a first full chiropractic appointment I will take a full medical history, examine the ankle and foot properly and watch how you walk, then give you an honest opinion on what is going on.

Ankle and foot problems bring a steady stream of people to my clinic here in Bournemouth a good many of them walkers who have discovered that the harbour paths and the soft sandy beaches are less forgiving than they used to be.

For the short-term management of an ankle sprain, hands-on care combined with the graded loading and balance work that carries the strongest evidence is a well-tolerated option worth considering and it is where I can be most confident about what treatment offers. For the wider range of foot problems, my job is first to work out what is actually driving it and to be clear about whether I am the right person to help. Some of what turns up in feet belongs with a podiatrist, a GP or a specialist and if that is what I find I will tell you.

Book an appointment online and you can choose what suits you: a first appointment, which is the full chiropractic visit with a detailed history, examination and treatment where appropriate or a free 15 minute consultation, which is simply a no-obligation chat about your problem with no examination and no treatment. If you are not sure which you need, call the clinic on 01202 937568 and we will work it out together.

Call, message or email, whatever is easiest and we will take it from there.

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