Ankle & Foot Injuries

The ankle and foot provide the foundation for all standing calisthenics movements. From pistol squat depth to jumping and landing mechanics, healthy ankles are essential. This chapter covers common ankle and foot injuries, prevention strategies, and rehabilitation approaches.

Red Flag Warning: Seek immediate medical attention for: obvious deformity, inability to bear weight after injury, severe pain and swelling following trauma, numbness in the foot, or open wounds associated with injury.

Ankle and Foot Anatomy Overview

The Ankle Joint

Talocrural joint (true ankle):

• Tibia and fibula above, talus below
• Primarily allows dorsiflexion (toes up) and plantarflexion (toes down)
• Mortise and tenon design for stability

Subtalar joint:

• Below the ankle joint
• Between talus and calcaneus (heel bone)
• Allows inversion (sole turns in) and eversion (sole turns out)
• Important for adapting to uneven surfaces

Key Ligaments

Lateral (outside) ligaments:

• Anterior talofibular ligament (ATFL)—most commonly sprained
• Calcaneofibular ligament (CFL)
• Posterior talofibular ligament (PTFL)

Medial (inside) ligament:

• Deltoid ligament—strong, less commonly injured

Syndesmotic ligaments:

• Connect tibia and fibula
• High ankle sprain involves these structures

Key Tendons

Achilles tendon:

• Largest tendon in the body
• Connects calf muscles to heel
• Critical for propulsion and jumping
• Common site of tendinopathy

Posterior tibial tendon:

• Supports the arch
• Important for stability
• Can become dysfunctional

Peroneal tendons:

• On the lateral ankle
• Evert the foot
• Can be injured with ankle sprains

Foot Structure

Bones:

• 26 bones in each foot
• Organized into hindfoot, midfoot, forefoot
• Arch structure (medial longitudinal, lateral, transverse)

Plantar fascia:

• Strong band on bottom of foot
• Supports the arch
• Common site of pain (plantar fasciitis)

Common Ankle and Foot Injuries

Ankle Sprains

What they are: Stretching or tearing of ankle ligaments, most commonly the lateral ligaments.

Types:

Lateral ankle sprain (most common):

• Inversion injury (rolling inward)
• Usually ATFL first, then CFL
• 85% of all ankle sprains

Medial ankle sprain:

• Eversion injury (rolling outward)
• Less common due to deltoid ligament strength
• May have associated fracture

High ankle sprain:

• Involves syndesmotic ligaments
• Usually from rotation with foot planted
• More serious, longer recovery

How they happen in calisthenics:

• Landing on uneven surface
• Losing balance during single-leg movements
• Jumping and landing with poor control
• Falls during skill training

Grading:

• Grade I: Mild stretching, minimal swelling, able to bear weight
• Grade II: Partial tear, moderate swelling and bruising, some difficulty with weight bearing
• Grade III: Complete tear, significant swelling and bruising, unstable, difficulty bearing weight

Symptoms:

• Pain and tenderness over affected ligaments
• Swelling
• Bruising (may appear hours to days later)
• Difficulty walking
• Instability feeling

Achilles Tendinopathy

What it is: Degeneration and pain in the Achilles tendon.

Types:

• Insertional: At the heel attachment
• Mid-portion: In the middle of the tendon (more common, better prognosis)

How it happens in calisthenics:

• Jumping and plyometric training
• Calf-intensive exercises
• Rapid increases in training volume
• Running as cross-training
• Hill work

Symptoms:

• Pain in the Achilles tendon (back of ankle)
• Morning stiffness that improves with movement
• Pain at start of activity, may improve, then worsen
• Thickening of the tendon
• Point tenderness

Risk factors:

• Recent increase in training volume
• Tight calf muscles
• Poor ankle mobility
• Previous Achilles issues
• Age (more common over 30)

Plantar Fasciitis

What it is: Inflammation or degeneration of the plantar fascia on the bottom of the foot.

How it happens:

• Repetitive loading (jumping, running)
• Tight calf muscles
• Limited ankle dorsiflexion
• Prolonged standing
• Sudden increase in activity

Symptoms:

• Pain on the bottom of the heel
• Worst with first steps in the morning
• Pain after prolonged sitting
• May improve with walking, then worsen
• Point tenderness at the heel attachment

Risk factors:

• Tight calves
• Flat feet or high arches
• Obesity
• Occupations requiring prolonged standing
• Recent increase in activity

Peroneal Tendon Injuries

What they are: Strains, tears, or inflammation of the peroneal tendons on the outside of the ankle.

Types:

• Tendinopathy (chronic irritation)
• Tears (acute or chronic)
• Subluxation (tendon slips out of groove)

How they happen:

• Often associated with lateral ankle sprains
• Repetitive inversion/eversion
• Direct trauma
• Can occur with normal sprains if severe

Symptoms:

• Pain and swelling behind and below the lateral malleolus (outside ankle bone)
• Pain with eversion (turning foot out)
• Snapping or popping sensation (if subluxation)
• Weakness in eversion

Posterior Tibial Tendon Dysfunction

What it is: Degeneration or injury to the posterior tibial tendon, which supports the arch.

Symptoms:

• Pain and swelling on the inside of the ankle and foot
• Flat foot deformity (may develop gradually)
• Weakness with single-leg heel raise
• Pain with prolonged standing or walking

Relevance to calisthenics:

• May affect single-leg balance
• Can impact squat mechanics
• May limit pistol squat performance

Stress Fractures

What they are: Small cracks in bone from repetitive loading.

Common locations in foot/ankle:

• Metatarsals (especially 2nd and 3rd)
• Navicular (serious, often missed)
• Calcaneus (heel bone)
• Fibula

How they happen:

• Repetitive impact (jumping, running)
• Rapid increases in training volume
• Poor footwear
• Nutritional deficiencies (calcium, vitamin D)
• Female athlete triad

Symptoms:

• Localized pain that worsens with activity
• May have swelling
• Point tenderness over the bone
• Pain may not be present at rest initially

Important: Navicular stress fractures are high-risk injuries that may not heal well without proper treatment. Don't ignore persistent midfoot pain.

Prevention Protocols

Ankle Strengthening and Stability

Calf strengthening:

Calf raises:

• Both legs, then single leg
• Straight knee and bent knee versions
• Progress to weighted and eccentric focus
• 3 sets of 15-20 reps

Eccentric calf drops:

• Rise on both feet, lower on one foot
• Important for Achilles health
• 3 sets of 10-15 each side

Ankle stability:

Single-leg balance:

• Progress from firm to unstable surfaces
• Eyes open, then closed
• Add movement challenges (reaching, catching)
• 3 sets of 30-60 seconds each side

Ankle alphabet:

• Trace the alphabet with your toe
• Improves mobility and proprioception
• Daily or before training

Eversion/inversion strength:

Resistance band exercises:

• Eversion against band
• Inversion against band
• Dorsiflexion against band
• 3 sets of 15-20 each direction

Ankle Mobility

Dorsiflexion (critical for squatting):

Knee-to-wall:

• Measure distance from wall
• Target 4+ inches from wall with knee touching
• 3 sets of 10-15 reps each side

Banded ankle mobilization:

• Band around front of ankle, pull backward
• Drive knee forward over toes
• Helps improve joint mechanics

Calf stretching:

• Straight knee (gastrocnemius)
• Bent knee (soleus)
• Hold 30-60 seconds each

Foot Strengthening

Intrinsic foot muscles:

Towel scrunches:

• Scrunch towel with toes
• Builds foot arch support
• 3 sets of 15-20 reps

Marble pickups:

• Pick up marbles with toes
• Improves toe control and strength

Short foot exercise:

• Shorten the foot by raising the arch without curling toes
• Builds arch support
• Hold 5-10 seconds, repeat 10-15 times

Proper Landing Mechanics

For jumping and dismounts:

• Land on whole foot, not just toes
• Absorb force by bending knees and hips
• Avoid valgus collapse at knees and ankles
• Land softly (quiet landing)
• Progress jumping volume gradually

Footwear Considerations

For training:

• Flat, stable shoes for squatting
• Appropriate support for jumping
• Consider barefoot training for proprioception (on safe surfaces)
• Replace worn shoes

Minimalist/barefoot:

• Can build foot strength
• Transition gradually
• Not appropriate for all individuals or activities
• Risk of stress fractures if too rapid a transition

Treatment Approaches

For Ankle Sprains

Acute phase (days 1-3):

• Protection (avoid re-injury)
• Optimal loading (gentle movement within comfort)
• Ice for pain management
• Compression to reduce swelling
• Elevation when possible

Early rehabilitation:

• Restore range of motion
• Begin weight bearing as tolerated
• Isometric exercises
• Gentle stretching

Progressive rehabilitation:

• Strengthen ankle in all directions
• Balance and proprioception training
• Progress to single-leg activities
• Return to sport-specific movements

Timeline:

• Grade I: 1-2 weeks
• Grade II: 2-6 weeks
• Grade III: 6-12 weeks (may need immobilization or surgery)

For Achilles Tendinopathy

Heavy slow resistance training:

• Slow tempo calf raises (3 seconds up, 3 seconds down)
• Both legs, progress to single leg
• Gradually increase load
• Continue for 12+ weeks

Alfredson protocol (alternative):

• Eccentric heel drops
• 3 sets of 15, twice daily
• Straight knee and bent knee
• Perform into mild discomfort

Insertional tendinopathy modifications:

• Avoid stretching below neutral
• Modify exercises to limit dorsiflexion range
• May have slower recovery

Expected timeline:

• 3-6 months for significant improvement
• May take up to 12 months for full resolution

For Plantar Fasciitis

Self-management:

• Calf stretching (most important)
• Plantar fascia stretching (pull toes back)
• Ice massage (frozen water bottle roll)
• Night splint (keeps ankle dorsiflexed while sleeping)
• Supportive footwear

Strengthening:

• Calf raises
• Intrinsic foot strengthening
• Gradual increase in activity

When conservative fails:

• Orthotics
• Physical therapy
• Injection therapies
• Rarely surgery

Expected timeline:

• Most cases improve within 6-12 months
• Can be stubborn

Return-to-Training Guidelines

After Ankle Sprain

Criteria for progression:

• Full range of motion
• Able to bear weight without pain
• Adequate strength
• Good balance

Functional tests:

• Single-leg balance
• Single-leg hopping
• Cutting and pivoting (sport-specific)

Return protocol:

• Gradual increase in activity
• May benefit from taping or bracing initially
• Continue ankle strengthening as maintenance
• Monitor for chronic instability

After Achilles Tendinopathy

Criteria:

• Able to perform single-leg calf raise without pain
• Tendon no longer thickened or tender
• Adequate strength and endurance

Return protocol:

• Gradual increase in jumping and running
• Continue heavy slow resistance training as maintenance
• Monitor for recurrence
• May take months

After Plantar Fasciitis

Criteria:

• Pain-free first steps in morning
• Able to walk and stand without significant pain
• Adequate calf and foot strength

Return protocol:

• Gradual increase in impact activities
• Continue stretching and strengthening
• Monitor for recurrence
• May need ongoing management

When to Seek Professional Help

See a healthcare provider if:

• Unable to bear weight after injury
• Significant swelling that doesn't improve
• Suspected fracture
• Pain that doesn't improve after 2-3 weeks
• Recurrent sprains or chronic instability
• Symptoms not responding to self-management

What to expect:

• Physical examination
• Possible imaging (X-ray, MRI, ultrasound)
• Diagnosis and treatment plan
• Physical therapy if indicated

Key Takeaways

1. Ankle sprains are common but not benign—proper rehabilitation prevents chronic instability
2. Achilles tendinopathy requires loading—not just rest
3. Ankle mobility affects the whole chain—limited dorsiflexion impacts knees and hips
4. Balance training is injury prevention—proprioception protects against sprains
5. Plantar fasciitis is often a calf problem—stretching calves is key
6. Don't ignore foot pain—navicular stress fractures are serious
7. Landing mechanics matter—absorb force through the whole body
8. Footwear affects function—choose appropriately for your training