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The ankle is a group of structures
The ankle connects your lower leg to your foot. The tibia and fibula, the two lower-leg bones, surround a foot bone called the talus. This joint mainly allows your foot to move up and down. Other joints below the ankle and within the foot help it adapt to uneven ground.
Ligaments connect bones and limit certain movements. Muscles act through tendons. After twisting your ankle, a ligament, bone, tendon or several tissues may be involved. The way an injury happened does not, by itself, establish that it is a sprain.
Chapter sources [1] [2] [3] [4]
Understand the picture
Three regions, several structures
Ankle
Joints and ligaments contribute to movement and stability.
Heel and arch
The Achilles acts behind the heel; the plantar fascia lies underneath.
Forefoot
Metatarsals, toes and nerves contribute to loading and push-off.
From the heel to the toes
At the back, the Achilles tendon connects your calf muscles to the heel bone. Underneath, the plantar fascia is a strong band of tissue that helps support the arch. At the front, the metatarsal bones and toes contribute to weight-bearing and push-off.
Nerves carry sensation and control muscles. Burning, tingling or reduced feeling does not necessarily mean a tendon problem. Skin, circulation and general health, including diabetes, also form part of the assessment.
How can you describe your symptoms?
Explain when symptoms began: a fall, a misstep, a new standing job, more activity or no clear trigger. Point to the area and describe whether symptoms stay there or spread. Mention swelling, stiffness and changes in sensation.
The first minutes in the morning, the end of a standing workday and the hours after sport provide different information. Note a task that has become difficult, such as going downstairs or walking to a shop. This often tells the clinician more than one pain score.
Which guide matches your question?
After a twist, start with the sprain and instability guide. For pain behind the heel, the Achilles tendinopathy guide distinguishes the middle of the tendon from its attachment. A sudden feeling of being struck behind the leg needs prompt assessment; a rupture has its own guide.
Pain underneath the heel is covered with plantar fascia pain and heel spurs. Forefoot pain, Morton’s neuroma, hallux valgus, hallux rigidus, arthritis and a changing arch have separate explanations. These pointers help you navigate; they do not confirm a cause.
When should you seek medical advice first?
After an injury, deformity, a significant wound, a cold foot or loss of feeling needs urgent care. Severe pain with inability to bear weight needs prompt assessment even if swelling is modest. Do not test the foot’s strength by hopping.
A red, hot and very painful joint, fever or a newly swollen foot in someone with diabetes also needs prompt advice. A newly swollen calf after immobilisation needs urgent assessment. With breathlessness or chest pain, call 112 in Luxembourg.
What does an assessment achieve?
The clinician connects your history with movement, walking, loading, strength and sensation. Footwear, activities, previous injuries and other conditions matter. Differences between feet may be useful to examine without necessarily being abnormal.
X-rays mainly assess bones and joints. Ultrasound and MRI answer other specific questions. Not every situation needs imaging, and a visible change does not always explain pain. Conversely, some bone stress injuries do not show on an initial X-ray.
How do treatments work together?
Treatment depends on the cause and what you want to regain. It may combine temporary protection, activity changes, more comfortable shoes, exercises and medical follow-up. A fracture or rupture needs specific instructions; an overload problem often needs a different progression.
Physiotherapy may address useful movement, strength and balance, followed by everyday and sporting tasks. Insoles, braces and medical procedures have a role in selected situations. They are not automatically necessary and do not always replace active rehabilitation.
In everyday life
An everyday journey becomes difficult
Describe
Explain when and where symptoms develop during the journey.
Adapt
Temporarily reduce a demand if weight-bearing is allowed.
Review
Compare walking, recovery and swelling over several days.
Moving while observing your response
Travel, stairs, standing and training add up during a day. If you reduce sport but double your standing time, the foot may remain heavily loaded. Spread permitted activities and observe walking and symptoms the following day.
When weight-bearing is allowed, begin with something manageable, such as a short level route. Increase one element at a time: duration, speed or difficulty. Sharp pain, increasing limping or unusual swelling means reducing the load and, depending on the situation, seeking advice.
Preparing for your appointment
Bring your prescription, useful reports and instructions received after surgery or immobilisation. Mention medicines, medical history and changes in sensation. Work or sports shoes may help explain a practical difficulty.
Choose one or two goals: collecting your children, working with fewer breaks or returning to a hobby. Ask when to make contact, how to adapt exercises and when to review progress. KinéCheck can help you prepare questions; it does not replace urgent assessment.
Following useful progress
Pain relief is not the only measure. Walking more regularly, recovering after a day, feeling steadier or wearing your usual shoes again also matter. These abilities may improve at different rates.
Arrange a review if progress is lacking, episodes recur or activities remain very limited. Do not wait until the end of a programme if a new concerning symptom appears. The following articles explain these stages for each situation.
Your questions
Does heel pain always mean a heel spur?
No. The fascia, Achilles tendon, bone or other structures may be involved. A spur visible on an X-ray can also exist without pain.
Chapter sources [6]
Do I need an MRI before physiotherapy?
Not routinely. The examination and medical question determine whether imaging could change care. Bring any investigations already completed.
Can I try every exercise?
No. Choose exercises suited to your situation and follow restrictions after fracture, rupture or surgery. The module explains precautions and reasons to stop.
Sources and references
- [1] Haute Autorité de Santé - Entorse du ligament collatéral latéral (ligament latéral externe) de cheville : diagnostic, rééducation et reprise de l’activité physique et de la pratique sportive
- [2] Guy’s and St Thomas’ — Achilles tendinopathy
- [3] AOPT/JOSPT — Heel Pain / Plantar Fasciitis: Revision 2023
- [4] Morton's neuroma - NHS
- [5] Entorse de la cheville : que faire et quand consulter ? | ameli.fr | Assuré
- [6] gesund.bund.de — Fersensporn und Plantarfasziitis
- [7] Bunions - NHS
- [8] Hallux Rigidus (Stiff Big Toe) - OrthoInfo - AAOS
- [9] Broken ankle - NHS
- [10] Stress Fractures - OrthoInfo - AAOS
- [11] Recommendations | Diabetic foot problems: prevention and management | Guidance | NICE
- [12] DVT (deep vein thrombosis) - NHS
- [13] En cas d'urgence - appelez le 112 - Informations utiles - Corps grand-ducal d'incendie et de secours (CGDIS) - Luxembourg
- [14] Dutch multidisciplinary guideline on Achilles tendinopathy
- [15] Kiné Diddeleng — informations pratiques confirmées
- [16] Achilles Tendon Rupture (Tear) - OrthoInfo - AAOS
- [17] Flat feet - NHS
- [18] Uniklinik Freiburg — platvoet, met afzonderlijke uitleg voor volwassenen
Text updated on
Medical review: awaiting Hasib Selimovic.