Foot and Ankle Clinic

Support for pain, mobility and confident movement

Foot and ankle problems can affect walking, standing, stairs, exercise and sport. Symptoms may begin after a twist or fall, develop following surgery or appear gradually as activity levels change.

A foot and ankle assessment looks at movement, strength, balance and how the foot and ankle respond to everyday activity. Physiotherapy can help with common problems including ankle sprains, plantar heel pain, Achilles tendon pain and foot or ankle arthritis.

When a foot or ankle assessment may help

You may benefit from an assessment if you are experiencing:

• Ankle pain or stiffness
• Pain around the heel or arch of the foot
• Achilles tendon pain
• Repeated ankle sprains
• A feeling that the ankle is unstable
• Swelling following an injury
• Difficulty walking or standing for longer periods
• Pain when using stairs
• Reduced ankle movement
• Weakness following an injury
• Pain during running or sport
• Difficulty balancing on one leg
• Foot or ankle pain after increasing activity
• Reduced mobility after surgery
• Difficulty returning to exercise

Foot and ankle pain can occur suddenly following an injury or develop gradually over time, so the treatment approach depends on how the symptoms started and how they currently affect movement.

Understanding foot and ankle pain

The foot and ankle need to manage body weight repeatedly during standing, walking, running and changes of direction.

A problem in this area may affect more than the painful movement itself. For example, pain or stiffness can change the way you walk, reduce confidence on uneven ground or make you rely more heavily on the other leg.

The assessment therefore considers movement, strength, balance and the activities that place demand on the foot and ankle rather than looking only at where it hurts.

What happens during your first appointment?

Your first appointment begins with a discussion about your symptoms and how they affect your routine.

The physiotherapist may ask:

• When the problem started
• Whether there was an injury
• Where you feel the pain
• Whether swelling is present
• Which activities make symptoms better or worse
• Whether the ankle feels unstable
• How symptoms affect walking or standing
• Whether you run, exercise or play sport
• Whether you have had previous ankle injuries
• Whether you have had surgery or other treatment
• What activities you would like to return to

The physical assessment may include:

• Foot and ankle movement
• Calf and lower-leg strength
• Balance
• Walking
• Single-leg movements
• Heel raises
• Squatting or stepping
• Areas of pain or tenderness
• Sport-specific movements where relevant

The findings help identify which areas may need attention and how rehabilitation should be progressed.

What treatment may include

Treatment will depend on the type of problem, how long symptoms have been present and your current ability.

Movement and mobility exercises

Exercises may be used to restore ankle and foot movement following pain, injury or surgery. Ankle movement exercises are commonly included after acute injury and during post-operative rehabilitation.

Strengthening exercises

Exercises may focus on the calf, ankle and muscles that support the foot.

Strength can be gradually increased as symptoms improve so that the foot and ankle are better prepared for walking, exercise or sport.

Balance and stability training

After an ankle injury, balance and confidence can sometimes be affected.

Exercises may progress from standing on one leg to more challenging movements involving stepping, reaching, jumping or changes of direction.

Walking rehabilitation

If pain, injury or surgery has changed the way you walk, treatment may include exercises and walking practice aimed at restoring a more comfortable pattern.

Manual therapy

Hands-on treatment may sometimes be used for stiffness, soft-tissue restriction or reduced joint movement where appropriate. It is generally combined with exercise rather than used as the only part of rehabilitation.

Home exercise programme

You may be given exercises to complete between appointments. These can be adjusted as movement, strength and balance improve.

Ankle sprains

An ankle sprain commonly occurs when the ankle twists and the supporting ligaments are stretched or injured. Pain, swelling and difficulty putting weight through the foot may follow.

After the early stages of an injury, rehabilitation may focus on:

• Restoring ankle movement
• Reducing stiffness
• Rebuilding calf and ankle strength
• Improving balance
• Increasing walking tolerance
• Reintroducing running or sport
• Improving confidence on the affected leg

Returning to activity before strength and balance have recovered may leave the ankle feeling unreliable, so rehabilitation is usually progressed gradually.

Repeated ankle sprains and instability

Some people continue to experience ankle instability after one or more previous sprains.

You may notice that the ankle:

• Feels unreliable
• Gives way unexpectedly
• Feels less stable on uneven surfaces
• Repeatedly rolls during sport
• Lacks confidence during jumping or landing

Physiotherapy is commonly used as an initial treatment for ongoing ankle instability and may focus on strength, balance and control.

Rehabilitation can progress from basic exercises towards running, jumping and sport-specific movements where required.

Achilles tendon pain

The Achilles tendon connects the calf muscles to the heel and is placed under considerable load during walking, running and jumping.

Achilles tendinopathy can cause pain at the back of the ankle and may also be associated with reduced strength. Changes in activity levels can contribute to the problem.

Treatment may include:

• Gradual calf strengthening
• Exercises that load the Achilles tendon
• Temporary changes to running or exercise
• Improving ankle movement where needed
• Gradually increasing walking or running tolerance
• A structured home exercise programme

Tendon rehabilitation often takes time and usually requires gradual progression rather than complete rest followed by an immediate return to full activity.

A sudden sharp pain, swelling or a popping sensation at the Achilles may suggest a more significant injury and should receive appropriate medical assessment.

Plantar heel pain

Pain underneath the heel is commonly associated with plantar fasciitis, sometimes referred to more generally as plantar heel pain.

Symptoms may be particularly noticeable when taking the first few steps after rest and may also increase during longer periods of standing or walking.

Physiotherapy may include:

• Foot and ankle exercises
• Calf strengthening
• Stretching where appropriate
• Advice on managing walking or running load
• Gradually increasing activity
• Guidance around footwear where relevant

The aim is to improve the foot’s ability to tolerate everyday loading rather than simply avoiding standing and walking.

Foot and ankle arthritis

Arthritis in the foot or ankle can contribute to pain, stiffness and reduced movement.

Symptoms may make longer walks, stairs or uneven ground more difficult. A person may also begin to change the way they walk to avoid discomfort.

Physiotherapy may focus on maintaining useful movement, improving leg strength and finding manageable ways to remain active. Foot and ankle arthritis is among the conditions commonly managed by musculoskeletal physiotherapy services.

Walking and standing

Foot and ankle symptoms often become noticeable because these areas are involved every time you take a step.

If pain has reduced your activity, rehabilitation may begin with shorter periods of walking and gradually increase distance as your tolerance improves.

Treatment may also include:

• Calf strengthening
• Balance exercises
• Step practice
• Walking on different surfaces
• Improving ankle movement
• Building tolerance to longer periods of standing

The goal is to prepare the foot and ankle for the activities you encounter in normal daily life.

Returning to running

Running places greater repeated demands on the foot and ankle than normal walking.

If an injury has stopped you running, rehabilitation will normally build through stages rather than moving directly back to your previous distance or pace.

This may include:

• Comfortable walking
• Calf strengthening
• Single-leg exercises
• Balance work
• Hopping or landing exercises
• Short periods of jogging
• Gradually increasing running distance
• Progressing speed or intensity

Achilles and heel problems are both commonly seen in runners, particularly when training demands change.

Returning to sport

Sports involving running, jumping and rapid changes of direction place additional demands on the ankle.

Later-stage rehabilitation may therefore include:

• Single-leg strengthening
• Jumping and landing
• Hopping
• Accelerating and slowing down
• Changes of direction
• Sport-specific drills

The progression depends on the injury and the activity you want to return to.

The aim is not simply to reach a point where walking is comfortable, but to prepare the ankle for the movements it will need to manage during sport.

Changes in activity and training

Some foot and ankle problems begin when activity levels change.

This may happen after:

• Increasing running distance
• Starting a new sport
• Returning after a period of inactivity
• Increasing gym or training frequency
• Spending much more time walking or standing

Achilles tendon problems, for example, may develop following changes in activity levels in either direction.

Treatment may involve temporarily adjusting activity while gradually rebuilding the strength and tolerance needed for your usual routine.

Footwear and everyday activity

The shoes you use can sometimes affect comfort during walking, work and exercise.

This does not mean there is one correct type of shoe for every foot problem. The most suitable option depends on the activity, symptoms and individual needs.

Where relevant, your physiotherapist may discuss footwear alongside exercise and activity management rather than relying on footwear changes alone.

Rehabilitation after foot or ankle surgery

Physiotherapy may form part of recovery following foot or ankle surgery.

The programme must take account of the procedure and any restrictions provided by the surgical team.

Depending on the operation and stage of recovery, rehabilitation may include:

• Restoring ankle or foot movement
• Managing stiffness
• Rebuilding strength
• Improving balance
• Walking with or without an aid
• Practising stairs
• Returning towards normal walking
• Returning to work or exercise

Physiotherapy is used following procedures such as ankle replacement and ligament reconstruction to help restore movement, strength, balance and function.

Recovery times vary considerably between procedures, so post-operative rehabilitation should follow individual medical guidance.

Balance and confidence after injury

Following an ankle injury, some people continue to feel cautious even after the initial pain has improved.

You may feel less confident when:

• Walking on uneven ground
• Stepping off a kerb
• Standing on one leg
• Running
• Jumping
• Changing direction
• Returning to sport

Balance and stability exercises can help gradually expose the ankle to these situations in a controlled way.

The exercises can become more challenging as confidence and physical ability improve.

Recurring foot and ankle problems

If symptoms repeatedly return, the assessment may look at what happens around each episode.

This may include:

• Previous ankle injuries
• Changes in training
• Strength
• Balance
• Walking or running demands
• Work requirements
• Long periods of reduced activity
• Incomplete rehabilitation

Treatment can then focus on improving the foot and ankle’s ability to tolerate those demands rather than only settling the current episode.

Do I need a scan?

Not every foot or ankle problem requires an X-ray, ultrasound or MRI scan.

Many common problems can initially be assessed through your symptoms, injury history and physical examination.

Imaging may be useful when a fracture, significant tendon injury or another condition is suspected. If the assessment suggests further investigation is appropriate, you may be advised to seek medical review.

When to seek further medical assessment

Some foot and ankle injuries should receive medical assessment rather than routine physiotherapy alone.

Seek appropriate medical advice if you experience:

• Severe pain following a significant injury
• An inability to put weight through the foot
• A visibly deformed foot or ankle
• Major or rapidly increasing swelling
• Sudden loss of movement or strength
• Persistent numbness or loss of sensation
• A hot, swollen joint accompanied by feeling unwell
• A sudden pop or snap around the Achilles followed by difficulty walking

Sudden sharp heel pain accompanied by swelling and a popping or snapping sound can indicate a significant Achilles injury.

If concerns are identified during your physiotherapy assessment, further investigation or medical review may be recommended.

Treatment based on your goals

Your rehabilitation should reflect what you need your foot or ankle to do.

Your goal may be to:

• Walk comfortably
• Stand for longer at work
• Use stairs confidently
• Return to running
• Exercise in the gym
• Return to sport
• Recover after surgery
• Walk over uneven ground
• Reduce repeated ankle sprains
• Feel confident using the affected leg again

The rehabilitation programme can be built around these activities and progressed as your strength, movement and confidence improve.

How many sessions will I need?

The number of sessions depends on the type of problem, how long symptoms have been present and the activities you want to return to.

A mild injury may need a relatively short period of rehabilitation, while tendon problems, recurring ankle instability or recovery following surgery may require a longer programme.

Your progress can be reviewed throughout treatment so that exercises continue to match your current ability.