Experiencing ankle or foot pain that is both annoying, torturous AND prevents you from walking or doing basic day-to-day tasks?

Foot pains are really common.

With each foot having 26 bones, 33 joints and over 100 muscles, ligaments and tendons, just injuring any single one of them will give us pain.

Not to mention that each year we take on average half a million steps (that’s more than 500,000+ steps!), so it’s no wonder that it’s just so easy to hurt our foot, our toes and more.

Feet or ankle pains can seriously limit your freedom to move around, work or take care of yourself or loved ones. When it’s painful to step or move about, everything can be annoying difficult.

You’re not alone with this.

Frankly, ankle and foot pains or injuries are so common and affects men and women, young and old. These can be caused by new injuries, old recurring unresolved issues or issues from young such as flat feet.

Painful ankle sprains, for example, is the most-most-most common form of ankle injury, and did you know, happens at least 25,000 times PER DAY in the United States ALONE. In Singapore, ankle sprains make up to 85% of all ankle pains or injuries.

Most of the time it comes from sports such as

  • football / soccer
  • badminton
  • basketball
  • hockey
  • jogging
  • hiking

…basically any sports or activities where you need to use your feet to move about…yes, people do sprain their ankles by even walking on flat ground!

The good news is that ankle and foot physiotherapy can help get you back on your feet.


Patients with ankle or foot aches and discomforts often pop painkillers to bear the pain and get through the day, but the problem with that is that it doesnt solve the problem. Yeah, maybe that may help with the pain for the moment…

…and the moment the painkiller wears off, the pain comes back.

What’s more, the longer the ankle or foot pain is unresolved, it’d just get worse, so the pain will worsen over time. To the extent to may possibly medically require ankle surgery…and you’d still need ankle physio after that.

Ankle and foot physiotherapy can help provide you a permanent solution to your ankle and foot pains, and may also help prevent the need for injections or surgeries. The reason is because our ankle physiotherapists do not only treat the symptoms and pains but also will fix the underlying cause of your ankle and foot pain.

Our ankle physios are experts on

  • foot pains
  • achilles tendon pains
  • plantar fasciitis pains
  • ankle sprains

and most importantly, experienced on your ankle foot treatments and recovery.

We will meet with you to assess your foot and ankle in-depth, dive-deep to identify the root problems, deal with the symptoms and create a personalized ankle foot physio program to get you back on your feet, pain-free and strong, to go back to do what you love and want to do.

We relieve pain, treat the injuries and conditions using techniques such as manual therapy, soft tissue and joint mobilization, electrotherapy such as ultrasound or shockwave where appropriate and very specific personalized exercises too.

Often we help patients prevent the need for painful foot or ankle injections or surgeries, and where necessary, we can refer you to good orthopedic doctors whom we trust and have worked with for years.

The #1 key is to understand and uncover the root cause of the pain (this is half the battle), and once that’s done, we can create your specific foot ankle plan to complete recovery no matter what your situation is – we will have a treatment plan for you that will get you back into your daily active lifestyle.


Ankle and / or foot pains can happen due to a number of different causes, and the most common are:

  1. INJURY to any of the bones, ligaments, tendons (such as ankle sprains) due to trauma, sports, falls
  2. ARTHRITIS such as rheumatoid, gouty arthritis or ankylosing spondylitis)
  3. MEDICAL / HEALTH issues such as gout or even cancer
  4. “UPSTREAM” issues higher up such as spine causing sciatica in the shin, ankle and foot
  5. WEAR-AND-TEAR such as osteoathritis, plantar fasciitis, achilles tendinopathy, snapping ankle, bunions, heel spurs


Here’s some common foot injuries (and what cause them) as well as treatments we recommend:

Plantar Fasciitis

This painful condition has so many names: subcalcaneal pain, painful heel syndrome, calcaneodynia, heel spur syndrome, runner’s heel, and calcaneal periostitis.

It’s really a foot condition that unfortunately WILL worsen over time without foot physiotherapy, because of the nature of its condition: it starts and worsen with physical stress and strain. What happens is that this will build up inflammation in the tissue that connects your heel bone to your toes.

Most patients report a sharp, even knife-like pain, when putting load on the foot / ankle in the morning or after immobility due to rest or work, but gets better as it “warms up” (in about 5-20 minutes, depending on severity).

Stress Fractures

Next on the list, is stress fractures.

This specific painful condition is commonly caused by overuse, very common in people who spend lots of time on their feet. Think of

  • runners / marathoners
  • military / guard / uniformed personnel

Typical symptoms of stress fractures include feeling like their heels are bruised, tenderness when you put some pressure onto the heel, and pain that gets worse over time.

Bunion Surgeries

A bunion is a painful bony bump that develops on the inside of the foot at the big toe joint. Bunions are typically associated with hallux valgus, a condition where the big toe leans toward the smaller toes.

Bunion surgeries are surgeries / treatments to correct the bony bunions at the big toe joint. There’s a number of different approaches to bunion surgeries and most of the time, patients can expect roughly 2-3 months for the big toe bone and joint to recover.

As the bone and joint heals, you will need physiotherapy to work on building / regaining foot and toe

  • range of motion
  • strength
  • stability
  • stamina

Posterior Tibialis Tendinopathy

Posterior tibialis tendinopathy starts with pain on the inner side / part of your foot. Patients report

  • pain in / around the tendon
  • ankle weakness
  • pain with / when doing a single leg heel raise
  • pain walking or running

Treatments revolve around manual therapy, gradual range of motion and strength training, followed by graded balance.

LisFranc Fractures

Lisfranc fractures happen when there’s broken bones or torn ligaments which support the inner / middle part of the foot. These kind of fractures’ severity can range from a single bone or ligament contusion (very mild) to very severe one involving multiple joints and bones.

Symptoms include

  • swelling / bruising at the middle, top or bottom of the foot
  • pain in middle of foot that worsens with load on it, such as when standing, walking and definitely when walking on it

Physio treatments vary depending on how mild or bad the injury is. Once the bone, muscle and joint is stable, we will first work to restore range, manage pain and work our way up the power, stability and stamina range.

Ankle fractures

Ankle fractures can happen when the force that goes through the ankle is too much for the ankle bones to bear, such as in awkward falls or traumatic accidents in sports or motorvehicular collisions.

If the ankle is (very) unstable, there’s a very high chance that your ankle will need an ORIF (open reduction, internal fixation) ankle surgery.

Management of ankle fractures are similar to Lisfranc fractures physiotherapy.

Mortons’ Neuroma

Morton’s neuroma involves a thickening of the tissue around one of the nerves leading to your toes.

And what this does is that it can cause a sharp, burning pain in the ball of your foot. You may have stinging, burning or numbness in the affected toes.


Any conditions or injuries to the ankle or foot will often cause

  • aches
  • pains
  • discomfort
  • difficulty putting weight or load through it (as in difficulty standing, walking on the affected foot or ankle)

In more severe cases, there can be

  • weakness
  • instability
  • unusual sensations such as tingling, numbness, shooting


Instead of self-diagnosing or guessing, and risking inaccurate diagnosis, I recommend that you consult our physios about your ankle or foot issues.

Also, the earlier any conditions are treated, often the injury will heal much faster eg a 1-day-old sprained ankle + physiotherapy at day 1 will ALWAYS heal faster than a 100-day-old sprained ankle of the same level of sprain with physiotherapy at day 100, even at same level of injury.

It is very important (and helpful too) to seek medical advice and treatment from an ankle physiotherapist to get an accurate diagnosis of your ankle and/or foot pains. I often share that knowing exactly what diagnosis you have is half the battle won, because it’s true.

After getting an accurate diagnosis, then you can get the right kind of treatment to resolve your foot and ankle pain or injury, rather than risking inaccurate self diagnosis or letting the ankle or foot pain worsen over time.

The good news is that most cases of foot pain will settle with careful and early foot physiotherapy management. Most of the very mild ankle or foot pains get better with simply

  1. rest
  2. avoiding activities that aggravate the pain
  3. ice
  4. over-the-counter pain medications

However, if the pain or discomfort lasts more than 7 days, or there’s instability, you’ll likely need to seek ankle physiotherapy and medical assessment.

We’ll need to assess and diagnose make sure that the injury isn’t very severe, such as in ankle fractures or ruptured tendons or ligament (and refer you to good trustworthy orthopedic doctors where necessary).

I’ve said this earlier, most of the ankle or foot pains usually do not require injections or surgeries, and will recover with ankle foot physiotherapy to manage the pain, improve the strength of the muscles that support your ankle and foot as well as build dynamic balance and proprioception.


Most cases of foot pain will settle down with simple treatment, but sometimes it’s worth discussing things with your doctor.

See your regular GP / family doctor if:

  • You have moderate foot pain
  • The pain is there all the time
  • Your foot symptoms have suddenly got worse
  • You have a high temperature with your foot pain
  • You notice that your lymph nodes are swollen e.g. in the neck or groin as this can be a sign of an infection
  • There is no improvement in your symptoms after a week
  • You have a medical condition that affects your circulation e.g. diabetes

Seek urgent medical attention (such as an orthopedic or emergency department) if:

  • You have severe foot pain
  • You heard a cracking or popping noise when you injured your foot
  • There is severe foot swelling and bruising
  • Your foot looks an awkward shape
  • You are unable to bear weight on your foot
  • You notice any changes in your bladder or bowel
  • You lose sensation in one or both feet


A lot of the mechanical aches, pains and injuries in our bodies come from our feet, for the main reasons of:

  1. carrying / undergoing the most load
  2. everyday / every moment we walk about

What can make this worse range from simple missteps, awkward landings, sports injuries or trauma from falls or accidents. Often, the most common thing that happens is we have those mild aching but recurrent micro-injuries, combined with a busy lifestyle, causing us to put off ankle foot physiotherapy.


Getting early ankle foot physiotherapy is the key accelerator to rapid ankle foot healing and getting back to normal walking and playing.

The reason is that an experienced ankle physio can quickly and accurately determine what

  1. ankle foot injury you specificly have
  2. what’s causing / caused it in the first place
  3. decide what’s the best treatment approach from there for ankle foot physio, or quickly referring you to an orthopedic doctor we trust where necessary

Just by doing this, we will

  1. get your ankle to recover in the shortest time and least effort required
  2. prevent future ankle and foot conditions
  3. prevent the ankle foot from developing chronic pains or degrading / worsening (worst case is requiring ankle surgery)

Unfortunately we do see a lot of ankle foot pain patients in our Novena and Tampines physio clinics who do their own research online and self-assess themselves by

  • researching their symptoms
  • researching cures, remedies and solutions

The problem is

  1. wrong diagnosis (mis-diagnosis) can and will cause aggravation of the old problem, and possibly cause new ankle foot problems to arise
  2. equally important is the delay of proper diagnosis and treatment can degrade the existing problem from a mild one, to a severe one (which may even need surgery possibly)

Our multi-disciplinary physiotherapy and ortho team is experienced and skilled in ankle foot pains, injuries and dysfunctions – we can determine if the issue is new (acute), long-standing (chronic), degenerative in nature (wear-and-tear) or an ankle foot problem that requires immediate medical attention (we will refer you to a trustworthy orthopedic doctor)


Ankle Sprains & Pains

A sprain or strain is a common ankle injury due to the stretching or tearing of ligaments. Ankle sprains make up of 85% of all ankle injuries in Singapore (that’s a LOT!), and it’s either caused by trauma or accidents, such as sports or falls…but sometimes, it can happen randomly too.

A number of our ankle patients report that they accidentally rolled or sprain their ankles walking on flat ground without tripping or slipping.

There’s 2 types of ankle sprains:

  1. Low ankle sprains are the most common types of ankle sprains, caused by rolling of the ankle (inwards or outwards)
  2. High ankle sprains are much more rare, and these happen when the large ligament above the ankle is injured

From the first day of your ankle injury, our ankle physiotherapists will do

  1. pain relief
  2. restore ankle range of motion and flexibility
  3. build strength
  4. restore proproceptive feedback (important to prevent future ankle sprains)
  5. build ankle stability (for performance and to prevent ankle instability)

Ankle Fractures

Ankle fractures happen when one or more of the ankle bones are fractured.

These are painful incidents that usually linked to even a simple misstep (it’s also commonly caused by accidents such as sports tackles, awkward falls, motorvehicle accidents).

Most of the time, older people experience more ankle fractures as their bones loses bone density with time and age.

Severity of broken ankles can vary:

  • for mild cases, you may be placed on an airboot / aircast and be able to walk around with mild to moderate pain
  • for more severe cases, you may be on non-weight-bear (NWB) or even may need an urgent ankle surgery for ORIF (open reduction internal fixation) to stabilize your ankle bones

Once your bones are stable, our ankle physios will work on

  1. restoring flexibility / range of motion
  2. building strength and stamina
  3. regaining balance

Note: there’s 2 shin bones, the larger weight bearing one is called tibia and the smaller floating one is called fibula. Usually when the fibular is fractured, you may still be allowed to walk around because most of the weight and load goes through tibia…but if the tibia is fractured, you may likely need surgery.

Ankle Physiotherapy after Ankle Surgery

Be it an ankle sprain, ankle tendinitis, ankle fracture or other ankle wear-and-tear pains, making an appointment with an experienced ankle foot physio will undoubtedly accelerate your recovery. Unfortunately, delays to treatment even in mild or minor aches or alignments in the body can possibly worsen to long term ankle foot pain later.

Our physiotherapists are experienced in orthopedic (prevention and post-surgery) rehab and work with recommended orthopedic protocols and guidelines to not just help but truly improve patient’s ankle and foot outcomes to return to full movement, power, stability and tolerance.

How fast and how well your foot and ankle heals after a surgery will be influenced by:

  1. how early you seek medical attention & physiotherapy
  2. skill and experience of doctor & physiotherapist
  3. how complicated or complex the injury was
  4. how early you start your foot and ankle physiotherapy
  5. how compliant you are to the sessions and home exercises between sessions
  6. if you had underwent pre-operative physiotherapy

In the early stages post surgery, there will always be

  1. swelling (we call this edema)
  2. pain
  3. reduced range of motion / flexibility
  4. muscle weakness (and some degree of atrophy)

More often than not, surgery will be required for

  1. unstable / complex fractures
  2. rupture ligaments / tendons

For complex fractures, the orthopedic surgeon will need to rejoin any bony fragments to the proper location and alignment, and secure them down usually with titanium screws and plates (kinda like armor).

Often too, the types of surgery will influence your post-surgery recovery. For example, if we compare:

  1. achilles tendon rupture reconstruction vs
  2. complex ankle fracture with resultant ankle fusion surgery

The achilles tendon reconstruction patient will typically get back to normal function within 6-12 weeks, whereas the one with ankle fusion may take 6 months to 9+ months of regular physiotherapy to get back to normal.

We will work and communicate closely with your orthopedic doctor to

  • communicate closely any findings and how to improve recovery
  • breakdown scar tissues and adhesions causing ankle joint stiffness using manual therapy, exercise therapy, shockwave or ultrasound therapy, etc

Achilles Tendon Pain / Achilles Tendinitis

The achilles tendon is the largest tendon that’s located at the back of our ankle.

If you’re experiencing aches, tenderness or pains in the achilles tendon, there’s a possibility that you have achilles tendinitis or tendinopathy – a very common injury where your achilles tendon becomes inflamed, irritated and painful.

Physiotherapy for achilles tendonitis:

  • pain management
  • deep tissue release of possibly over-strong / compensatory calf and hamstring muscles
  • stretching out tight structures
  • gradual tendon tensile loading, strengthening and stability training after

Foot and Ankle Arthritis

Physiotherapy treatment for foot and ankle arthritis depends on

  • the type of arthritis
  • the severity of the arthritis

Types can range from the regular osteoarthritis and degenerative changes to gouty arthritis and rheumatoid arthritis too.

As I mentioned earlier, osteoarthritis is the most common of the folk, it’s caused by normal use and wear-and-tear, and if it’s the patient does not go for ankle arthritis physio, there is a chance for early ankle joint replacement surgery.

What happens with arthritis (and arthritis pain) is that the muscles of the painful part may start to work less (to decrease pain experience), and this causes other muscles and other body parts to compensate for that, and this causes the compensating structures to overwork, overload and ends up being strained.

What our ankle and foot physios will do is to identify these kind of compensatory imbalance and provide a personalized plan to course-correct the problem. We will treat the soft tissues for pain relief and to ease the load on the ankle joint…

…but if the ankle joint is too worn out and bone is starting to hit on bone, there will be a lot of pain and at this point, patient may benefit from ankle joint replacement. Other cases where patient will benefit more from ankle joint fusions, what the orthopedic doctor will do is to fuse the ankle bones together permanently, which takes a longer time to recover.


Early & Immediate Ankle and Foot Pain Relief

We always spend more time during the first (initial) ankle foot physio session, so that we can do an in-depth deep-dive to accurately identify the diagnosis and the core / root causes of it.

Then we will start with pain relief (always first) with manual therapy, soft tissue management, releasing tight knots where found, ultrasound therapy.

This will help you walk out of our clinic in less pain than when you first came in through the same door earlier…and also allow you to move about and do things more than your ankle foot was painful.

From Pain Relief…To Effectively Better Than Before.

Here in SGPainRelief.com, we want to treat and get you improved as soon as possible with as little sessions too.

After finding out the diagnosis and the root causes of the diagnosis, next, we will formulate a personalized foot and ankle recovery plan for you.

Then we’ll start the treatment process so that you can have lasting pain relief AND full ankle foot flexibility, strength, stability and stamina.

The overall goal is to get you back to as good as pre-injury, or even better than before.


When do I need to see a doctor for my foot or ankle pain?

There are various levels to ankle sprains. The good news is that most ankle sprains are simple and usually heals on their own.

However, if your foot or ankle pain is severe and persistent, you should seek immediate medical attention.

Otherwise, you should consider seeing a doctor or physio if:

  • You have persistent swelling that doesn’t improve after a few days
  • You have persistent pain that doesn’t improve after a couple of weeks
  • You experience any burning, numbness, or tingling in your foot or lower leg

What can I do to prevent ankle sprains?


There’s a few ways to prevent ankle sprains:

    1. warm up before exercising or sports (such as running, hiking, team sports etc)
    2. wear (and change) your shoes that have good support for the sports or activity
    3. schedule rest and prevent over-training or over-straining – your foot and ankle needs rest too, so schedule breaks and rest, and do not over train
    4. reduce frequency of high impact sports and/or alternate with low-impact sports such as aqua aerobics or swimming

Is there any treatments for flat feet?

I (Nigel) also have flat feet, and there’s 2 kinds of flat feet:

  • naturally occurring ones
  • collapsed arches

Usually the naturally occurring ones do no present with pains or problems in the body or ankle; and more often than not, patients with collapsed arches are the ones who tend to develop foot and ankle pains.

Our physios will assess your feet to determine the diagnosis and causes of your foot / ankle pain and plan the best treatment plan for you, such as manual therapy, soft tissue management, stretches or exercise therapy or even custom orthotics.

My ankle sprains are frequent, but it’s common – do I really have to see a physiotherapist for it?

Best answer: yes, for long term ankle and foot stability, strength and stamina.

Patients who ignore the micro-injuries, aches and problems of the foot and ankle can ignore it in the short term with painkillers, but when left unresolved or untreated, these foot and ankle problems will recur (come back) again and again…but also worsen.

Where To Next?