Ankle & Foot Pain

Ankle and foot pain is defined as pain arising from the anatomical region of the ankle and foot. It may arise traumatically or from degenerative change, congenital conditions or inflammatory arthropathies.


The diagnosis of ankle/foot conditions relies mainly on the patient’s history and physical examination. Imaging studies are indicated for morton’s neuroma or in the presence of potential pathology [109].

Evidence based summary for manual therapy [53]

The highest quality of scientific trials show there is moderate quality evidence (on a scale of low, moderate and high) that manual therapy of the foot and/or full kinetic chain (SI to foot) combined with exercise therapy is effective for plantar fasciitis [121].

Chiropractic treatment has been found beneficial in comparison to usual care the prevention of Lower Limb Muscle Strain injuries in players of Australian Rules Football in a single blinded randomised controlled trial. Those in the intervention group and receiving chiropractic care had a statistically significant reduced risk of injury – injury rates were 3.6% in the intervention group and 27.6% in the control group. This had a large impact on missed matches. There were only 4 missed matches for lower limb muscle strain for the 28 players in the intervention group who completed the trial, 21 missed matches for the 29 in the control group [106].

Short-term management of ankle sprains by chiropractors is supported by the literature [157-160]. For ankle sprains there is inconclusive evidence in a favourable direction for the effectiveness of manual therapy with multimodal or exercise therapy [53]. Manual mobilization has been shown to have an initial effect on dorsiflexion (toe to knee) range of motion after ankle sprains [125].

Other evidence for the chiropractic approach to lower leg problems

There is evidence to support chiropractic approach to help care for patients with lower extremity conditions [108].

There is evidence to support the effectiveness of exercise and manual therapy to help and prevent ankle sprains [118 -120].

Other effective non-invasive physical treatments or patient education [53]

Stretching and foot orthoses for plantar fasciitis [122], ankle supports for ankle sprains [126]

Back-in-Action Clinic Comment

Chiropractic treatment of ankle and foot conditions initially is based on promoting soft tissue healing and relieving pain.

Self help recommendations of using ice or heat is often given in the acute stage and it is recommended to limit aggravating activities. Nutritional approaches can be beneficial to help support soft tissue healing.

Cross friction massage and muscle release techniques may be applied. Areas of severe muscle spasm may also benefit from massage or acupuncture. An emphasis is placed on self help exercise which might include self mobilisation, stretching, strengthening and balance training.

Both pain relief and preventative approaches focus on improving the movement, position and stability of the lower leg and related structures in order to reduce the risk of stress and further tissue damage. Core stability exercise often is useful for improving the position of the low back, pelvis and hip. Functional neurological treatment and exercises are sometimes helpful.

Foot orthotics, heel lifts, sitting advice and other ways to improve postural problems affecting the lower leg may be suggested to help prevent reoccurrence. Education on running style and preparation can be useful.

Chiropractic adjusting techniques (manipulation) and mobilisation may be applied to the foot and ankle and to improve the function of related joints in the lower back and leg.

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