Foot and Ankle Pain Guide
Don't worry, you are NOT alone. The ligaments in the ankle are THE MOST commonly sprained ligaments in the body. But don't worry, when guided in the right direction you can get out of pain fast! We have put together a guide to to answer some of the questions you may have..
We Get You
Ankle and foot pain can be real annoying, we get it. We understand how discouraging it can be to want to stay active when you don’t know if what you are doing is helping or hurting.
Yes, we have been there and yes, we have helped many others like you (and ourselves) who are experiencing ankle and foot pain get through this process.
We are former athletes who know both our physical and mental happiness is heavily dependent upon how active we can be throughout the week. So we get it.
Here’s the thing; you are stronger than you think and you can and WILL get through this.
What’s the key you ask?
First, is mindset. You need to be open to getting helped through this process by a professional who is trained to do so (we will tell you what to look for in your practitioner later).
Not only do you need to be open, you owe it to yourself to shift from thinking of yourself as broken to knowing that you can and will get through this.
This shift in mindset creates action and fosters consistency. Two absolute musts in your recovery process.
Second, is structure. To get the result you want FAST, you need a solid framework you can depend on.
This is where a solid practitioner who gets your needs and goals will be crucial. We will be diving into this a bit deeper so sit back and enjoy.
Common Causes of Ankle and Foot Pain
Let’s clear the air a little here. You are NOT alone. First off, the ligaments in the ankle are the most commonly sprained ligaments in the body. And trust us, we both have experienced more than a few in our lifetimes.
BUT not to worry... when guided in the right direction, you can get out of pain and FAST.
“I was told to just avoid (insert favor activity here) and my ankle pain will be good”.
We’ve been there, trust us! As you will find out later in this article, oftentimes avoiding activity completely is NOT helpful.
Also being told to avoid something without a plan of action doesn’t get you closer to where you want to go. Yes, being told what not to do is important, but having guidance throughout the process is a GAME CHANGER.
“I was given a list of exercises with no guidance and no one helped me”.
One of our biggest pet peeves! This is BS and you absolutely deserve better.
Your practitioner’s job is to guide you with feedback to make the recovery process as FAST as possible. If he or she is not there to give you direction, do you think you are getting the care you deserve?
"Can my foot pain be coming from my back?"
This may sound crazy but it is much more common than you think. The nerves that come out of the low back come together to form a big nerve called the sciatic nerve. This nerve travels all the way down into your foot.
So if you have a back issue that irritates these nerves coming out of the back it can cause foot pain, even if you do not experience back pain. If the pain is really stemming from your back, all of the rolling stretching or smashing you are doing for your foot pain will not help you in the long run.
So here is an easy exercises you can do to make sure this is not the case for you.
“I was told to wear a boot for my plantar fasciitis and I will heal”
This advice is not bad at all. However, if this is the only advice then it is very short sighted.
Let us explain.
If you boot up for a long time then once you take it off and go right back to what you were doing before, what do you think will happen? If you answered foot pain, you are most likely correct.
Here is why. You are skipping an important part of the recovery process: the rebuilding phase where your body builds resilience and strength to withstand the forces of the activities you enjoy. This is really important to prevent future injury. If you skip this step, you are asking for future foot pain or ankle pain.
If you could minimize the risk for future foot pain and ankle pain would you do it? Let’s assume that answer is a yes.
Here are a couple of safe exercises you can deboot and give a whirl for your foot pain pretty early in the recovery process:
“I just don’t understand why my ankle keeps hurting or what’s going on in there”
You deserve answers, but answers take time. It takes a thorough assessment and sometimes some trial and error to get to the bottom of what is causing your pain.
This is why we take time with you during our assessment so we know what YOUR goals are. And it doesn’t stop there. Throughout your management plan, we are constantly gathering data WITH you to get to the bottom of the cause and make any necessary adjustments on the fly that will be best for you.
This allows us to give you a plan that works for YOU.
How You Move
The foot or ankle is often not the true cause of the pain you are experiencing. Most likely it is a mobility or stability/control issue of neighboring areas.
It still remains important to find out what tissues are sensitive in the foot or ankle so you can take some stress off and protect it for a bit (hence why we are not against the boot in a lot of cases). However, if you never address the cause of the problem it will probably come back.
I will put it this way, your ankle or foot is just crying out for help similar to a victim getting robbed. Would you put the person getting robbed in jail? Probably not right? So why attack you foot and ankle when the problem can be coming from your hip?
To give you a better idea of what I am talking about, let’s take a look at how the human body functions in an ideal scenario. This is a very simplified version of a detailed picture, but is VERY useful. Take a look at this picture:
Simply put our body varies from mobile joint to stable joints stacked on top of each other. So starting at the big toe where the joint should be mobile (think propelling yourself forward, you need lots of big toe extension) then going up the chain the midfoot should be stable (this area is does the majority of the balancing when we are on one foot when walking, running, etc.).
This alternating pattern continues up the kinetic chain and if one joint is disturbed it usually affects the joint directly above or below, but can cause trouble all the way down the kinetic chain.
For example, if your ankle lacks the mobility to flex during bending movements like squatting, you will need to get that movement from somewhere else. That movement often will come from the knees, which increases mechanical stress on the structures of the knee. Enter higher chance of knee pain.
Your brain will figure out a way to get the job done, whether you have mobility in certain places or not. Typically the natural movement for you will be the path of least resistance, which makes sense as conserving energy was once pretty important to us back when we had to hunt and gather for our survival.
So if the mobility in one area in the body is not available, we will most likely ask more from the surrounding joints. This can lead to some unwanted results.
See how that works? What is great about this model is you can apply it to the entire body and learn where and how to implement movement drills for desired results.
So how does this apply to the foot or ankle? Well, I am glad you asked.
There are a few common scenarios that causes unwanted stress on that low foot and ankle.
- The big toe does not have the mobility to extend fully so every step you take running that stress is now shifted to the mid foot. Enter plantar fasciitis.
- The hip joint do not have the coordination to control your leg in space. This increases side-to-side movement of your leg. Enter sprained ankle, plantar fasciitis and any other specific foot pain or ankle pain.
- The ankle does not have the mobility it should and that stress is now placed on your midfoot. Yes you guessed it, here comes plantar fasciitis.
- ...I think you get the picture here.
Like we said before your body will find that mobility somewhere in order to complete a task that your brain may have for you. This puts added stress on your ankle or foot causing pain.
A great way to decrease stress on that sensitive ankle or foot is to make sure your big toe is mobile and your hips and core are more stabilize/coordinated during activity. This allows your body to access more motion through the big toe and stabilize your leg in space, giving that ankle and foot of yours a much needed breather.
Now the next time your brain asks your body to bend forward, reach over head or get down to the ground the stress will be spread out since you have unlocked some motion that previously was not available in those areas. The human body is cool.
In this next section, let’s talk about pain and how it works.
Breaking the pain cycle
The key to getting out of pain is breaking the pain cycle early and often. But what does that even mean?
Let’s get into it.
Everyone has experienced pain at one point in their life and I am sure you have to. We often hear how everyone experiences this sensation differently, which is entirely true and is why it can be so complex.
Simply put pain is a warning system from the brain similar to an alarm. When reaching over a hot stove you didn’t know was on, pain tells you to take your hand off that hot stove, dummy. Or it tells you to limp if you have a thorn in your foot until you can take it out and heal from it.
However if pain has been present for quite some time or reoccurs often for you, your alarm system can be placed on high alert.
We compare this to an overly sensitive car alarm. You know, one that your shirt brushes up against and it starts yelling at you? This is what can happen to you when you have had persistent pain.
The car alarm should only go off when someone is trying to steal it or break into it, not walk by it. Just like you should only feel pain when true harm is done.
We need to recalibrate your alarm system to only go off when someone is trying to steal your car, not when someone walks next to it.
To do this it is important to find positions or movements that make your symptoms feel better, even if just for a few minutes. Once you find it, do it often.
This breaks the pain cycle and starts to recalibrate your alarm system out of high alert and back to normal.
Keep in mind this process takes time. If you have been feeling the pain for 5 plus years, give yourself some time. Measure things like how long the exercise breaks the pain cycle for. If it was 5 minutes one week and 10 minutes the next week, that is a huge win!
Here are a couple of things you can try and see how your body responds.
Finding What Hurts
Finding out the things that make your symptoms worse is a HUGE step to figuring out a solid game plan to get you out of pain. A lot of the times there are multiple movements that have overlapping common characteristics. Again, big time in creating a plan.
Like we said before, the key to getting out of pain and staying out of pain is breaking the pain cycle early and often. The earlier you start and the more persistent you are, the better off you will be.
This starts with finding out what hurts and removing it. After all if you are not in pain, you are inherently breaking the pain cycle.
Sometimes it is important to realize that simply removing whatever is giving you problems has a higher priority than getting more things to “fix” you.
This is why it is very important to be aware of what activities bring on your symptoms. You cannot change what you are not aware of.
As you are becoming more aware of what gives you pain and trying to remove things to see what helps, be aware that all information is good information. Even if something wasn’t successful in relieving pain, that is GREAT to know.
Now you can take that off the table and try something else. If something works, great! Now increase the dosage and implement more of that.
We already know how complex pain and the body can be so it is a continual game of trial and error and seeing what works best for you.
What DOESN’T Hurt
Now that we know what to stay away from, let’s talk about what we CAN do. The important thing here is you know that you should definitely remain active through your recovery (keep in mind this does not mean doing the same stuff that got you there, there will be modifications).
Now the question becomes “How do I know the movements are not causing harm?”.
That my friends is an EXCELLENT question so let’s answer it shall we?
First, you do not need to perform a bunch of movements that are focused at the ankle and foot to get the health benefits you need. In fact, it can be doing more harm than good.
Think about it if an area is injured like in this case the ankle or foot, why would we stress it even more? Doesn’t make sense right?
So I challenge you to not only think about your foot or ankle, but also remember what we talked about before how important that big toe mobility and hip/core stability is to relieve your foot pain or ankle pain in the long run.
In addition, stability in the mid foot is a great way to control your foot whenever you take a step or get on one foot. We spend over 80% of the time on one foot whenever we are in motion so this is pretty important.
Here is a good exercise you can try:
- Make sure you do this one barefoot and root your foot into the ground. Slow and controlled is what we are after here.
So what next? Remember we have established the foot or ankle to be the site of pain so we have to find ways to avoid picking the scab. Mobilizing that big toe will be crucial to this process.
Here are some solid big toe mobility moves to try!
- Again, go barefoot here and really sit back to feel the big toe extension. Caution: if you have knee pain this one might not be for you.
This one is great because it not only hits big toe mobility but also some core stability. Once it is easy go to one foot.
Next, find a movement of the ankle or foot that feels good or actually rids the pain. Know this is not always possible and if there is a BUNCH of inflammation. If this is the case for you take it easy and give it a couple of days to calm down, then try it again. So try any one of the above exercises and see which is best for you.
Finally, general movements that you would see in a normal gym routine can be greatly beneficial for numerous reasons (endorphin and hormone release that cause pain relief and antidepressive effects are just a couple good reasons).
Keep it simple here. Pick two lower body movements and two upper body movements that do not cause your foot or ankle any pain then put them together for a workout.
To sum it up the following is a great guide to finding movements that will not further injure your neck.
- Don’t have tunnel vision on the foot or ankle
- Mobilize your big toe and stabilize the hips
- Stabilize your core/torso
- Find a movement that feels good
- Keep working the rest of your body in a pain free zone
Your management plan is essentially the template or roadmap to getting you out of pain, becoming more mobile and ultimately getting back to where you want to be: active and pain free.
We like to think as your management plan as a continuous assessment. This way we are getting constant feedback from you and we are able to be fluid and make changes that fit your needs and concerns as they come up.
Your management plan should include prescribed movements or modifications that either provide pain relief (think of this as your natural aleve) or make the body more resilient.
You should also be given advice on how to perform daily activities in the safest manner as to not pick the proverbial scab. This part is crucial as it often overlooked/undervalued that addresses the habits that got you into this situation in the first place.
It is also important that you walk out with advice on how to modify any exercise routine or sporting activities that you do. Let’s use the gym as an example here.
Maybe you have been dealing with a foot pain problem while running. Upon further examination, the pain is greatly decreased with changing how fast your feet hit the ground (cadence). The less steps per minute, the better it feels.
A simple fix for this person could be running faster intervals with walking in between. This will take stress off the sensitive area for that person.
You see how important that could be for your recovery?
If you leave the doctors feeling great but go back to doing the same shit that got you there, your results won’t last. This is why it is very important that your practitioner provides you with advice and safe modifications in your routine. Seriously, it is an absolute must!
Finally your management plan should include hands on manual therapy techniques that provide relief and can oftentimes be self administered (i.e. foam rolling, joint mobilizing, etc)
So here is what you should take home with a solid structured management plan:
- Pain relieving exercises or body positions
- Exercises that build resilience
- Advice on safe alternatives to daily activities
- Advice on safe modifications on workout routines or sporting activities
- Manual therapies that can be self administered
What to expect from us for your first visit
Let me just start by saying this; if your doctor does not spend at least 30 minutes with you to figure out a solution to your pain, walk out of the door and find someone else to help you.
Here is what to expect when you visit us for the first time.
A thorough history where we ask you from top to bottom about the experience you are having related to your foot or ankle. This is very important to us and should not take any less than 20 minutes.
The information in the history points us in the direction we want to start going with you during the physical exam. The history provides us with your goals and personal concerns which is vital for us to know in order to help guide you to where you want to be.
After we know and understand what you are experiencing in regards to your ankle or foot pain or tightness, it is time to figure out what tissues are sensitive.
This process is the structural exam where we put your body in different positions that places stress on specific structures. This tells us roughly what part of the body is hurting you.
Keep in mind these tests may be painful and we are only doing so to know what hurts. Knowing this will give you a better long term management plan and treatment. This process is paired with a more functional exam.
After we find out what body part is sensitive, we then assess how you move your body during common movements that are needed for everyday activities (i.e. squatting, reaching overhead, bending forward, etc).
This information tells us what may be causing your pain and how we can make some small adjustments that will go a very long way in your recovery process.
Now that we know your goals, your experience in relation to your pain, what body part hurts you and why, we can begin the treatment.
Your treatment will be individualized for you and YOUR specific goals. Often times this looks like trying many movements/exercises and seeing which one gives you the best result.
Other times it will look like manual therapy/body work in order to calm down the pain response. This depends your wants, needs and at what part of the recovery process you are in.
Your management plan is a sum of all of the information we have gotten to this point. It’s essentially taking all of the information and summing it up into bullet points. This acts as your game plan or script to take your health into your OWN hands.
This my friends is where the power lies and where YOU put in the work to get better.
As you can begin to see, this process takes time to find the cause of your pain and provide a solution. You absolutely deserve this time!
This is why we spend anywhere from 30 min to 90 min with our patients on the first visit.
Here is a list of what you should expect when coming for your first visit.
- Structural Exam (Assessment of what tissues are painful)
- Functional Exam (Assessment of how you move and how it may relate to your pain)
- Management Plan
What We expect From You
Prioritization of your health. At this point you will need to prioritize getting healthy as high as possible on your list of to-do’s.
This is a process and you WILL get better. However you will be with us for 30 minutes to an hour 1-3x per week. You need to be accountable to the rest of the week when we are not with you.
The true value is not just what we can do to decrease your symptoms in office. You will almost always feel some immediate relief. However it takes time for long term changes in movement and motor patterns to set in. The great thing is you will be continually getting better during the whole process.
In order for this process to work we need your help and commitment to follow the game plan. If you have had pain for years we probably don’t have a magic bullet to fix it with 1 visit.
We always aim to decrease your symptoms as fast as possible.
However, in more chronic cases we need to identify a pattern and habit that could trigger symptoms. This is the what not to do portion.
Second, we need to find movements that help you get better (the what to do portion). Think of your exercises as a prescription.
If you were sick and were prescribed an antibiotic that worked on a dose response IE: take every 4 hours and you and didn’t the antibiotics may not reach the desired effect.
Think of what we give you as a movement prescription but instead of an antibiotic every 4 hours you mobilize your t-spine. It’s important that you do your homework and ask us questions and express any concerns that come to mind during this process.
When do I need to get an X-ray/MRI
Imaging should be done only when things do not add up in an exam. An image just gives us better insight on what your anatomy looks like.
What it does NOT tell us is what areas are giving your sensation of pain.
Just like every other aspect of the exam, these images are just a piece of data that needs to be correlated to everything else that is gathered in the history and exam.
Though this information can be very useful in certain scenarios, it can also be harmful in others.
For example, if someone is told they have degenerative changes in their knee (which is extremely common and often does not cause pain) they can then become fixated on this and be fearful of movement.
Degenerative changes is just a medical term for aging or response to stress. This doesn’t always have a significance on the recovery process.
So here is when we think it is a good idea to get imaging:
- ANY of the red flags mentioned in the next section
- There has been a solid trial of a thorough management plan like we mentioned in the management plan section with no change and we just need more information.
- Things do not add up in your first visit and we need more data to give the best management plan for you
Keep in mind when we say exam we mean a complete exam, not the 10 minutes where the doctor scans the area asks you 2-3 questions and performs a minimal structural assessment.
This happens ALL OF THE TIME and it breaks our hearts when our patients come in and tell us this was their experience.
But in a nutshell, imaging is often not necessary to get you out of pain and back to an active lifestyle.
Red Flags are symptoms that can be related to very sinister diagnoses that require immediate attention and urgent intervention.
Please take these seriously and seek attention by a medical provider if you have the following:
- Fever or night sweats
- Unexpected weight loss
- History of inflammatory arthritis, cancer or infection
- Pain that is not dependent upon body position/cannot be reproduced by body position
- Intractable night pain
- Progressively worsening numbness, tingling or muscle weakness into the arms/hands
- Gross balance issues (i.e. you noticed yourself tripping or falling more recently)
- Clumsy hands (i.e. difficulty with texting/typing, buttoning shirts, etc)
- Cold sensation down the legs
- Numbness in the saddle area (genital region)
- Bowel or bladder dysfunction (pain when urinating, inability to hold back urine, increase urge or inability to fully void bladder)
- Menstrual cycle disturbances
- Drop attacks, double vision, nausea
What to Look for When Finding a Doctor
We are going to keep it short and sweet in a list format for you.
- Someone who gives you the time you deserve to find a solution (remember if you are seeing a doctor who is supposed to find a solution to your pain and you are there for less than 30 min… find a new doctor)
- Someone who is concerned about YOUR goals
- Someone who can give you a game plan that fits your needs and goals
- Someone who addresses the activities that may be causing your pain (if necessary)