Ankle sprains are the most common sporting injury and the most commonly under-treated one. Heel pain from plantar fasciitis and Achilles overload are equally frequent in people who stand or walk long hours. Correct early management prevents the chronic instability and stiffness that bring patients back years later.
Symptoms checklist
- Pain and swelling around the outer ankle after twisting
- First-step heel pain in the morning
- Pain and thickening at the back of the heel
- Repeated giving way on uneven ground
- Difficulty pushing off or standing on tiptoe
- Deformity, bunion pain or altered footwear wear pattern
When to see a doctor
- Unable to take four steps after an injury
- Bony tenderness over the malleoli — a possible fracture
- A sudden painful snap in the calf with weakness (possible Achilles rupture)
- Numbness, coldness or discolouration of the foot
- Persistent swelling beyond six weeks
Common causes
Lateral ligament sprain
Inversion injury damaging the ATFL and CFL, leading to instability if rehabilitation is incomplete.
Plantar fasciitis
Overload of the plantar fascia at the heel, causing classic first-step pain in the morning.
Achilles tendinopathy or rupture
Degeneration or a sudden tear of the tendon during a push-off movement.
Ankle impingement and cartilage lesions
Bone spurs or osteochondral defects producing catching, deep pain and reduced dorsiflexion.
Deformity
Flat foot, bunion or acquired deformity altering load distribution across the foot.
Treatment ladder
Treatment always begins with the least invasive option that can work — surgery is considered only when simpler measures have been given a fair trial.
- 1
Step 1
Self-care
Relative rest, ice, compression, elevation and supportive footwear or heel cushioning.
- 2
Step 2
Physiotherapy and orthotics
Balance and proprioception retraining, calf eccentric loading, plus custom insoles where mechanics need correction.
- 3
Step 3
Injections and PRP
Selected injections or PRP for stubborn plantar fascia and tendon problems that resist loading programmes.
- 4
Step 4
Ankle arthroscopy
Key-hole clearance of impingement, cartilage procedures and ligament repair for chronic instability.
- 5
Step 5
Reconstructive surgery
Ligament reconstruction, Achilles repair or deformity correction when structural change is established.
