Common questions about foot and ankle pain

The best-known sign is pain under the heel with the first steps after waking or after sitting for a long time, which eases a little after a few minutes of walking and may come back after long standing or walking, together with pain when pressing on the underside of the heel. It is more common after an increase in activity or long standing on hard floors, with extra body weight and with tight calf muscles. Diagnosis usually rests on your story and a clinical examination, and most people do not need a scan unless the pain does not improve with treatment or the doctor suspects another cause.

Read more: Heel pain · Source: AAOS OrthoInfo — Plantar Fasciitis and Bone Spurs · Koc TA Jr et al. (2023). Heel Pain — Plantar Fasciitis: Revision 2023. J Orthop Sports Phys Ther 53(12):CPG1–CPG39

No, although they are often mentioned together. The plantar fascia is a strong band of tissue under the foot running from the heel to the toes, and irritation of it is the most common cause of pain under the heel. A heel spur is a small bony outgrowth on the heel bone that may show on an X-ray, and most people who have one have no heel pain. So the spur is not usually the cause of the pain, and treatment targets the fascia, the muscles and the load on the foot, not the spur itself.

Read more: Heel pain · Source: AAOS OrthoInfo — Plantar Fasciitis and Bone Spurs · Koc TA Jr et al. (2023). Heel Pain — Plantar Fasciitis: Revision 2023. J Orthop Sports Phys Ther 53(12):CPG1–CPG39

In most cases it improves, but it can take a while. The pain may last for months, yet most people get better without surgery within months of simple, regular treatment such as stretching, managing load and suitable footwear. It can come back if walking or standing suddenly increases or the exercises are dropped, so a gradual return to activity and keeping up the exercises help. If it has not improved after two weeks of home care, is severe, or keeps coming back, get it assessed.

Read more: Heel pain · Source: AAOS OrthoInfo — Plantar Fasciitis and Bone Spurs · NHS — Heel pain

No, a heel spur is not dangerous, and it is often present without any pain. The common heel pain of plantar fasciitis is troublesome but not dangerous, and it usually improves with simple treatment. But see a doctor if the pain is severe or stops your normal activities, if you have numbness or tingling in the foot, or if you have diabetes and heel pain. Sudden severe pain after an injury, with a snap or being unable to walk or stand on tiptoe, needs the emergency department the same day.

Read more: Heel pain · Source: AAOS OrthoInfo — Plantar Fasciitis and Bone Spurs · NHS — Heel pain

Usually not. Plantar fasciitis causes pain under the heel, especially with the first steps in the morning or after sitting, rather than numbness. Numbness, tingling or burning in the foot usually points to a nerve cause instead, such as a trapped nerve near the ankle or in the lower back, or nerve damage in people with diabetes. So numbness in the foot is worth seeing a doctor about or having a careful assessment, especially if you have diabetes, and sudden numbness or weakness needs urgent care; if it affects one side of the body or comes with a drooping face or difficulty speaking, call an ambulance: 911 in Jordan or 122 in Iraq and Kurdistan.

Read more: Heel pain, Sciatica · Source: Koc TA Jr et al. (2023). Heel Pain — Plantar Fasciitis: Revision 2023. J Orthop Sports Phys Ther 53(12):CPG1–CPG39 · NHS — Heel pain

Heel pain from plantar fasciitis or a heel spur does not usually cause obvious swelling of the foot. Redness and swelling at the heel may point to irritation or inflammation there, and a hot, red, swollen heel with a fever needs a doctor the same day. Swelling of both feet has other causes, such as long periods of standing or sitting, some medicines, or heart, kidney or vein problems. Swelling of one leg with no known cause, or with redness or heat, needs urgent care, and with shortness of breath or chest pain, call an ambulance: 911 in Jordan or 122 in Iraq and Kurdistan.

Read more: Heel pain · Source: NHS — Heel pain · NHS — Swollen ankles, feet and legs (oedema)

The bony outgrowth itself usually does not disappear, whether with onion, henna or home mixtures, and there is no scientific evidence that these dissolve it. The good news is that it does not need to disappear for the pain to go: most people with a spur have no pain, and heel pain improves for most people with exercise, managing load and suitable shoes while the spur stays the same on the X-ray. Spurs are not usually removed surgically, because they are not usually the cause of the pain.

Read more: Heel pain · Source: AAOS OrthoInfo — Plantar Fasciitis and Bone Spurs · Yalcin E et al. (2012). Effects of extracorporal shock wave therapy on symptomatic heel spurs: a correlation between clinical outcome and radiologic changes. Rheumatol Int 32(2):343–347

Treatment targets the painful fascia, not the bony spur. It usually includes cutting down for a while on what makes the pain worse without stopping movement, stretching the calf muscles and the plantar fascia, then gradual strengthening of the foot and calf, with comfortable shoes that have a low heel, a soft sole and supportive insoles. Ice wrapped in cloth and a painkiller recommended by a pharmacist may ease the pain for a while, but they do not treat the cause. Manual therapy and taping can help as part of the plan, and dry needling may be added when suited.

Read more: Heel pain, Dry needling · Source: Koc TA Jr et al. (2023). Heel Pain — Plantar Fasciitis: Revision 2023. J Orthop Sports Phys Ther 53(12):CPG1–CPG39 · NHS — Heel pain

Most people need neither, because the pain usually improves with simple treatment. Shockwave therapy is not expected to break up the spur: pain may ease after it while the spur stays the same on the X-ray. It is sometimes used for heel pain that persists despite treatment, but the evidence on how well it works is mixed, and the decision is the doctor’s. Surgery is rare and is usually considered only after many months of non-surgical treatment without improvement; the spur is not usually removed, and the decision belongs to the orthopaedic surgeon.

Read more: Heel pain · Source: Yalcin E et al. (2012). Effects of extracorporal shock wave therapy on symptomatic heel spurs: a correlation between clinical outcome and radiologic changes. Rheumatol Int 32(2):343–347 · AAOS OrthoInfo — Plantar Fasciitis and Bone Spurs

Usually not. Most sprains are a stretch or partial tear of the ligaments on the outer side of the ankle after the foot rolls over, and they improve without surgery with brief protection, then gradual loading and exercise, although they hurt and can happen again if rehabilitation is skipped. But go to the emergency department if the ankle looks deformed, you heard a crack with severe pain, or the foot becomes cold, pale, blue or numb. See a doctor the same day if you cannot walk four steps, or the ankle becomes hot and red with a fever.

Read more: Ankle sprain · Source: NHS — Sprains and strains · Martin RL et al. (2021). Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision 2021 — Clinical Practice Guidelines. J Orthop Sports Phys Ther 51(4):CPG1–CPG80

In the first days, protect the ankle and take weight off it, raise the foot on a pillow when you sit or lie down, hold a cold pack wrapped in cloth to it for a few minutes several times a day, and use a compression bandage or support if needed. Avoid hot water, hot packs and massage on a new, swollen injury in the first days. Then start moving the ankle and walking on it gradually as comfort allows, rather than resting for a long time. If you cannot stand on it, or the pain and swelling get worse, see a doctor.

Read more: Ankle sprain · Source: NHS — Sprains and strains

Yes, swelling and bruising on the outer side of the ankle are among the most common signs of a sprain, and the bruise may spread towards the foot. Swelling usually goes down gradually over the following days and weeks; raising the foot, a cold pack wrapped in cloth and a compression bandage help, while heat and massage are best avoided at first. Some mild swelling can last longer after a severe sprain. Severe, rapid swelling, swelling that keeps increasing despite rest and raising the foot, or swelling with heat and redness needs a doctor.

Read more: Ankle sprain · Source: NHS — Sprains and strains · Martin RL et al. (2021). Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision 2021 — Clinical Practice Guidelines. J Orthop Sports Phys Ther 51(4):CPG1–CPG80

In most cases, neither. It is usually best to support the ankle with a bandage or brace and walk on it gradually as comfort allows, because long immobilisation can slow recovery. For severe injuries a doctor may decide on a short period in a brace or cast for some days. Surgery is not the first option; it is usually considered only if the ankle stays unstable despite a structured exercise programme over several months, or when there are other injuries in the joint, and the decision belongs to the orthopaedic doctor.

Read more: Ankle sprain · Source: Martin RL et al. (2021). Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision 2021 — Clinical Practice Guidelines. J Orthop Sports Phys Ther 51(4):CPG1–CPG80 · Vuurberg G et al. (2018). Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. Br J Sports Med 52(15):956

The same injury can sometimes cause a fracture, while a sprain is an injury to the ligaments that does not show on an ordinary X-ray. That is why doctors use the Ottawa ankle rules: if you cannot walk four steps after the injury, or pressing on the back edge or tip of either ankle bone, or on the bony points in the middle of the foot, hurts, you may need an X-ray, so see a doctor the same day. The doctor may request an MRI if another injury in the joint is suspected or recovery is slow.

Read more: Ankle sprain · Source: Martin RL et al. (2021). Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision 2021 — Clinical Practice Guidelines. J Orthop Sports Phys Ther 51(4):CPG1–CPG80 · NHS — Sprains and strains

Some pain or tightness in the lower leg can be felt after a sprain, and it usually settles as you recover. But clear pain above the ankle or when pressing on the leg bone, or severe pain when standing, may point to another injury, such as damage to the ligaments that join the two leg bones or a fracture, and needs an examination. Throbbing calf pain with swelling in one leg, sometimes with red or darkened skin, especially if you have not been able to move around much, may be a clot: see a doctor the same day, and with shortness of breath or chest pain call an ambulance: 911 in Jordan or 122 in Iraq and Kurdistan.

Read more: Ankle sprain · Source: Martin RL et al. (2021). Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision 2021 — Clinical Practice Guidelines. J Orthop Sports Phys Ther 51(4):CPG1–CPG80 · NHS — DVT (deep vein thrombosis)

Not every mild sprain needs sessions, but exercise matters for everyone. Evidence suggests guided exercise, especially balance work on one leg and strengthening, improves recovery and lowers the chance of another sprain, and works better than relying on passive treatments alone. Physiotherapy is especially useful after a severe sprain, if sprains keep happening, if pain or a feeling of instability lingers, or if you want to return to sport. At Revibe we progress with you from regaining movement to balance, then running and jumping.

Read more: Ankle sprain, Sports injuries · Source: Martin RL et al. (2021). Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision 2021 — Clinical Practice Guidelines. J Orthop Sports Phys Ther 51(4):CPG1–CPG80 · Vuurberg G et al. (2018). Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. Br J Sports Med 52(15):956

Usually not. Achilles tendon pain, which many people call tendonitis, usually comes from too much load on the tendon, and most people improve with progressive loading exercise and adjusting their activity, although this can take weeks to months of patience. Complete rest is not recommended, and neither is ignoring the pain and carrying on at full load. A sudden snap or a feeling of being hit at the back of the ankle, followed by difficulty walking or rising onto your toes, may mean the tendon has torn: go to the emergency department the same day.

Read more: Achilles tendon pain · Source: Chimenti RL et al. (2024). Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision – 2024 — Clinical Practice Guidelines. J Orthop Sports Phys Ther 54(12):CPG1–CPG32 · NHS Fife — Achilles tendon rupture (patient information)

The core is progressive loading exercise for the tendon and calf muscles, such as heel raises standing on both feet and then on one, with the load increased slowly as you tolerate it. A tolerable amount of pain during exercise is often acceptable if it settles by the next day. It also helps to cut down on running or jumping for a while instead of stopping completely, then build back up gradually, and a heel lift in the shoe may help for a time. If things do not improve despite a regular programme over a reasonable period, the doctor may discuss other options, and decisions on injections and surgery are the doctor's.

Read more: Achilles tendon pain · Source: Chimenti RL et al. (2024). Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision – 2024 — Clinical Practice Guidelines. J Orthop Sports Phys Ther 54(12):CPG1–CPG32 · de Vos RJ et al. (2021). Dutch multidisciplinary guideline on Achilles tendinopathy. Br J Sports Med 55(20):1125–1134

Signs of a rupture include sudden pain at the back of the ankle or in the calf with a feeling as if someone kicked or hit you there, sometimes a snapping sound, then difficulty pushing off or climbing stairs and being unable to stand on tiptoe. If this happens, stop the activity and go to the emergency department the same day, because early diagnosis and treatment matter, and the doctor decides between immobilising the foot and surgery. Gradual rehabilitation with physiotherapy then follows the doctor's instructions.

Read more: Achilles tendon pain, Sports injuries · Source: NHS Fife — Achilles tendon rupture (patient information) · NHS — Heel pain

Yes, these are names for the same tendon. The Achilles tendon, also called the heel cord, is the strong tendon at the back of the ankle that joins the calf muscles to the heel bone, and it works with every step, jump and rise onto your toes. It is named after the Greek hero Achilles, whose only weak spot, the legend says, was his heel. Its best-known problems are tendon pain from overload and, less often, a sudden rupture.

Read more: Achilles tendon pain · Source: Chimenti RL et al. (2024). Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision – 2024 — Clinical Practice Guidelines. J Orthop Sports Phys Ther 54(12):CPG1–CPG32 · Cleveland Clinic — Achilles Tendon (Calcaneal Tendon)

There is no single answer: whether flat feet count as a disability or exempt you from military service is decided only by the official medical committees in each country under their own rules, and the criteria differ between countries, so ask the recruitment authority in your country rather than relying on what people say. Medically, flat feet are common, usually cause no problems and do not stop most people from being active or playing sport. If your feet are painful, stiff, weak or numb, or the flat foot is new or affects only one foot, it is worth having it assessed.

Read more: Inner ankle pain and flat foot · Source: NHS — Flat feet

If flat feet cause no pain or problems, they need no treatment. If they are painful, wide comfortable shoes with a low heel, supportive insoles, stretching and strengthening exercises for the foot and leg, and a painkiller when needed may help. These do not change the shape of the foot, but they can ease pain and stiffness and improve movement. In adults, an arch that has dropped recently can be linked to strain on one of the foot's tendons, so it is worth an early assessment. Surgery is rare and is considered only for a bone or tissue problem that has not improved with other treatment; the specialist decides.

Read more: Inner ankle pain and flat foot · Source: NHS — Flat feet · Royal National Orthopaedic Hospital NHS Trust — A patient's guide to adult acquired flatfoot deformity (tibialis posterior tendon dysfunction)

Usually not; many people have flat feet without any pain. But they can sometimes cause pain around the ankle or lower leg, aching along the inner side of the foot, or shoes that wear out quickly. In adults, especially middle-aged women, a recently dropping arch with pain or swelling inside the ankle can be a sign of strain in the posterior tibial tendon, which is best treated early with exercise, physiotherapy and suitable insoles. So pain, or a flat foot that is new or affects only one foot, is worth having assessed.

Read more: Inner ankle pain and flat foot · Source: NHS — Flat feet · Royal National Orthopaedic Hospital NHS Trust — A patient's guide to adult acquired flatfoot deformity (tibialis posterior tendon dysfunction)

They can run in families, and often there is no clear cause other than how the foot is built. They are usually not a disease: the whole sole touches the ground without a clear arch, most young children have flat feet, and the arch usually develops between the ages of three and ten. Rarely, flat feet come from bones not forming properly before birth or from conditions affecting the nerves and muscles. They are worth assessing if they are painful, stiff or affect only one foot.

Read more: Inner ankle pain and flat foot · Source: NHS — Flat feet

Brief numbness after sitting on your foot or pressing on it is common and goes within minutes. Numbness that lasts or keeps coming back needs a doctor; causes include diabetes, a trapped nerve in the back as in sciatica, some medicines and drinking too much alcohol, and if you have diabetes and notice numbness or a wound on your foot that is not healing, see your doctor soon. Call an ambulance straight away, 911 in Jordan or 122 in Iraq and Kurdistan, for sudden numbness or weakness down one side of the body with a drooping face or difficulty speaking, which may be a stroke, or for numbness around the buttocks or genitals, or a new problem passing urine or stool.

Read more: Sciatica · Source: NHS — Pins and needles · NHS — Symptoms of a stroke

No, they are two different problems, although many people mix them up. A foot corn is a small patch of thick, hard skin on the toes or the sole, caused by pressure and rubbing from shoes, especially tight or high-heeled ones, and it can hurt when you walk. Wide, comfortable shoes with a low heel and a soft sole usually help; do not cut it yourself, and see a GP or podiatrist to treat it, especially if you have diabetes or poor circulation. A heel spur is a bony outgrowth on the heel bone that shows on an X-ray and often causes no pain, and pain under the heel with the first steps in the morning usually comes from plantar fasciitis.

Read more: Heel pain · Source: NHS — Corns and calluses · AAOS OrthoInfo — Plantar Fasciitis and Bone Spurs

Sometimes. Leg pain has many causes, including muscles, tendons, overuse or a nerve in the back. But pain that comes on with walking and goes after a few minutes’ rest may be a sign of narrowed leg arteries, which is linked with a higher risk of heart disease and stroke and is more common with smoking, diabetes, high blood pressure and high cholesterol: see a doctor. Throbbing pain with swelling in one leg, usually in the calf, may be a clot in a vein: see a doctor the same day. Call an ambulance, 911 in Jordan or 122 in Iraq and Kurdistan, if this comes with shortness of breath or chest pain, or a leg or foot suddenly turns cold, pale and painful.

Source: NHS — Peripheral arterial disease (PAD) · NHS — DVT (deep vein thrombosis)