Evidence-based care at Vantage Point
Ankle Physiotherapy in Bondi Junction
Assessment and treatment for ankle pain and ankle injuries, from sprains and an ankle that keeps giving way to Achilles tendon pain and ruptures, with a clear explanation of what is going on and a plan built around strength, balance and load.
- APA Musculoskeletal Physiotherapists
- Calf and ankle strength testing with VALD
- Rehabilitation before and after ankle and Achilles surgery
Symptom profiles
Which best describes your symptoms?
Ankle pain presents in distinct ways, and how it started and where you feel it point to different structures and a different starting point for treatment. Select the one closest to yours.
Achilles Tendon Pain and Rupture
Pain, stiffness or a sudden injury in the Achilles tendon at the back of the ankle. Tendon pain usually builds gradually with running or a jump in activity, while a rupture happens suddenly, often with a snap or the feeling of being kicked.
You might notice
- Stiffness in the Achilles when you get out of bed
- Pain at the start of exercise that eases, then returns later or the next day
- A sudden pop at the back of the ankle and difficulty rising onto your toes
What is usually happening
Achilles pain usually means the tendon has become sensitive to load after training increased faster than it could adapt. Tendons respond to progressive loading, and heavy slow strength training and eccentric training gave similar improvements over a year. A rupture can be treated with or without surgery: in a trial of 554 adults, function at 12 months was similar either way, with rerupture more common without surgery and nerve injury more common with it (Beyer et al., 2015; Myhrvold et al., 2022).
Common causes
Mid-portion tendinopathy
Pain in the tendon a few centimetres above the heel, the most common type.
Insertional tendinopathy
Pain where the tendon attaches to the heel, often aggravated by hills and stretching.
Achilles rupture
A complete tear, treated in a boot with or without surgery, followed by a structured rehabilitation program.
What we look at in your assessment
Where the pain sits, tendon loading and hop tests, calf strength and endurance with VALD dynamometry, and your running technique with video analysis. If a rupture is suspected, we confirm it with clinical tests and refer you promptly to a sports physician or orthopaedic surgeon.
How treatment usually starts
For tendon pain, adjusting training rather than stopping completely, then progressive calf and tendon loading, measured as you go. After a rupture, a staged program from the boot to full weight bearing and a return to running and sport based on strength milestones, working with your doctor or surgeon.
Related services
Ankle Sprains and Ligament Injuries
Pain and swelling after rolling or twisting the ankle, stepping off a kerb, landing from a jump or changing direction. Ankle sprains are one of the most common injuries in sport and everyday life.
You might notice
- Swelling and bruising around the ankle
- Pain walking, especially on uneven ground
- A stiff, weak ankle in the days that follow
What is usually happening
Rolling or twisting the ankle stretches or tears the ligaments that hold the joint together. Most sprains recover well with an exercise-based plan, and tape or a brace can ease pain early. Even so, 4 in 10 people followed for a year after a first sprain developed ongoing instability, which is why the later stages of rehab matter (Doherty et al., 2016; Vuurberg et al., 2018).
Common causes
Lateral ligament sprain
The ligaments on the outside of the ankle, the most commonly injured after rolling it.
High ankle sprain
An injury to the ligaments joining the two shin bones, often from a twist with the foot planted, and slower to recover.
Medial ligament sprain
The strong ligament on the inside of the ankle, usually injured with a fracture or a high ankle sprain.
Fracture
Tenderness over the bone or being unable to take four steps can mean an X-ray is needed.
What we look at in your assessment
Swelling, ligament tests and the Ottawa ankle rules to check whether you need an X-ray, then balance, hop tests and calf strength with VALD dynamometry as the ankle settles.
How treatment usually starts
Early protected movement and walking, with tape or a brace if it helps, then progressive balance, strength and agility work, and a return to sport based on milestones.
Related services
Ankle Pain in Runners and Athletes
Ankle pain that builds with running, jumping or kicking, or lingers after an old injury, common in football, basketball, dance and running.
You might notice
- Pain at the front of the ankle when squatting or landing
- Pain on the outside of the ankle or behind the ankle bone
- Pain that builds with training and settles with rest
What is usually happening
Repeated loading in deep or end-range positions, or a jump in training, can irritate the tendons, joint lining and bones around the ankle. Most settle with load management and progressive strengthening. Bone pain that builds with running needs prompt assessment for a bone stress injury.
Common causes
Ankle impingement
Pinching at the front or back of the ankle with deep squats, landing or pointing the foot.
Peroneal tendinopathy
Pain in the tendons behind the outer ankle bone, often in runners and after sprains.
Bone stress injury
Pain in a bone that builds with running or jumping, needing early diagnosis and a structured return.
What we look at in your assessment
Your training load and running or landing technique with video analysis, ankle range, and calf and ankle strength with VALD dynamometry. If a bone stress injury is suspected, we arrange imaging through your GP or a sports physician.
How treatment usually starts
Load management and a modified training plan agreed with your coach, progressive strength and tendon loading, and a graded return to full training based on milestones.
Related services
Recovery After Ankle Surgery
Rehabilitation before and after ankle surgery, from fracture fixation to ligament reconstruction and Achilles repair, starting when your surgeon advises and following their protocol.
You might notice
- Swelling and stiffness after your operation
- Difficulty walking normally once you are out of the boot
- Wanting to get back to walking, work or sport
What is usually happening
Restoring ankle movement and calf strength are two of the most important goals after ankle surgery, staged to protect the repair. Balance and calf strength often lag behind, so we test them before you return to running and sport.
Common surgeries
Ankle fracture fixation
Plates and screws to hold a broken ankle, with a staged return to weight bearing.
Ligament reconstruction
Repair or reconstruction of the outer ankle ligaments for an ankle that keeps giving way.
Achilles tendon repair
Open or minimally invasive repair, followed by a staged program out of the boot.
Ankle arthroscopy
Keyhole surgery for impingement or a cartilage injury.
What we look at in your assessment
Your surgeon's protocol, swelling and range of movement, walking, balance, and strength testing with VALD dynamometry once it is safe to test.
How treatment usually starts
Before surgery, prehab builds strength and range. Afterwards, settling swelling and restoring movement come first, then staged strengthening and balance work within your surgeon's limits, progressed by measured milestones. We communicate with your surgeon throughout.
Related services
Ankle and Heel Pain in Children and Teenagers
Ankle or heel pain in a growing child or teenager, after a sprain or building over a busy sporting season, sometimes with no clear injury.
You might notice
- Heel pain with running and jumping, often during a growth spurt
- Ankle pain or swelling after a twist that is slow to settle
- An ankle that keeps rolling or feels stiff
What is usually happening
During growth, the growth plates and the areas where tendons attach to bone are softer and more sensitive to load than in adults, especially when training increases during a growth spurt. Most adolescent heel and ankle pain settles with the right load management and strengthening, without needing to stop sport completely. Pain that does not settle after a sprain needs a closer look, as some injuries in growing bones need imaging.
Common causes
Sever's disease
Heel pain where the Achilles attaches to the growth plate of the heel bone, common in active children.
Growth plate injury
An injury to the growing ends of the shin bones after a twist, which can look like a sprain.
Ankle sprain
Ligament injuries, increasingly common as teenagers play faster, more physical sport.
Persistent ankle pain
Ongoing pain or stiffness after a sprain can come from a cartilage injury or joined foot bones, and may need imaging.
What we look at in your assessment
Growth stage, training load across all sports, an ankle and foot examination, and strength and balance testing with VALD dynamometry. A parent or guardian attends appointments with patients under 18.
How treatment usually starts
Load management across school sport and club training, progressive strength and balance work, and a plan the young person, parents and coach can follow, with a graded return to full training.
Related services
Ankle Instability and Recurrent Sprains
An ankle that keeps rolling or feels like it might give way, often months or years after a first sprain, sometimes with ongoing pain or swelling.
You might notice
- Rolling the ankle again with little force
- Feeling unsteady on uneven ground or when changing direction
- Holding back in sport because you do not trust the ankle
What is usually happening
After a sprain, the balance and reaction control around the ankle often do not fully recover without targeted training, and the ligaments can heal a little longer than before. In 522 athletes, a home balance training program after a sprain reduced repeat sprains by 35% over a year (Hupperets et al., 2009).
Common causes
Reduced balance and control
Slower reactions and weaker muscles around the ankle, a common reason it keeps giving way.
Ligament laxity
Stretched ligaments that let the joint move more than it should.
Associated injuries
Cartilage, tendon or bone injuries that can be missed after a sprain and keep symptoms going.
What we look at in your assessment
Ligament laxity tests, balance and hop tests, calf and hip strength with VALD dynamometry, and a review of any scans. If the ankle keeps giving way despite good rehabilitation, we arrange a surgical opinion.
How treatment usually starts
A progressive balance and strength program, sport-specific agility work, and a brace or tape for sport while you rebuild. Most people start with rehabilitation, and surgery is reserved for ankles that do not respond to it.
Related services
Pain under your heel, in your arch or in the ball of your foot? See foot physiotherapy.
Understanding ankle surgery
Surgery Is Not Always the First Step
For Achilles ruptures and ankle sprains, research has compared surgery with nonsurgical care built around rehabilitation.
The results show why we usually start with a structured plan, and why surgery remains the right choice for some people. When it is, we work with your surgeon before and after the operation.
Achilles rupture: outcomes at 12 months
Tendon rerupture
Nerve injury
554 adults aged 18 to 60 with an acute Achilles rupture. Function at 12 months was similar in all three groups. Surgery lowered the risk of rerupture and added a risk of nerve injury (Myhrvold et al., 2022).
What other research has found
Ankle sprains: exercise first
An international clinical guideline recommends exercise-based treatment, with tape or a brace, for most ankle sprains, and reserves surgery for ankles that do not respond to thorough rehabilitation (Vuurberg et al., 2018).
Recurrent sprains: balance training helps
In 522 athletes who had recently sprained an ankle, a home balance training program lowered the rate of another sprain over the following year from 33% to 22% (Hupperets et al., 2009).
Your treatment
Five Steps, Each With a Clear Goal
Every consultation is 45 minutes. Your plan is built around what matters to you, whether that is walking on the sand, a morning run or getting back to the court.
- 1
Assess
A detailed history and examination of your ankle, foot, knee and hip, including the Ottawa ankle rules to check whether you need an X-ray.
Goal: A clear diagnosis
- 2
Explain
What is causing your pain, what to expect, and which activities are safe to keep doing.
Goal: Confidence to keep moving
- 3
Settle
Hands-on treatment, dry needling where it helps, tape or a brace if needed, and changes to how you load the ankle to calm swelling and pain.
Goal: Pain and swelling under control
- 4
Strengthen
Progressive calf, ankle and hip strength with balance and hopping work, and VALD dynamometry to compare sides and track change.
Goal: Strength and balance targets met
- 5
Stay well
A return to running, sport or full activity based on milestones, and a plan to keep your ankle strong and stable.
Goal: Back to what matters to you
Injections
Where Injections Fit
Injections such as platelet-rich plasma (PRP) are often offered for Achilles pain that has been slow to settle. A large trial gives a clear picture of what to expect.
We do not give injections ourselves, but we often see people who are considering one, and we work with the GP, sports physician or specialist who provides it.
PRP for Achilles tendinopathy
No better than a placebo injection
In 240 people with Achilles tendinopathy, a PRP injection gave no better tendon function at 6 months than a placebo (sham) injection (Kearney et al., 2021).
How we work with injections
Loading still does the work
Whether or not you have an injection, progressive loading is what builds the tendon's capacity, so it stays at the centre of your plan.
The research
What the Research Tells Us
Ankle sprains
Exercise-based care is recommended
For most ankle sprains, a clinical guideline recommends supervised exercise, with tape or a brace, over rest and passive treatment alone (Vuurberg et al., 2018).
Lasting symptoms
4 in 10 still had symptoms at a year
Of 70 people followed for a year after a first ankle sprain, 28 (40%) developed chronic ankle instability (Doherty et al., 2016).
Recurrent sprains
Balance training reduced repeat sprains
A home balance training program after an ankle sprain reduced the risk of another sprain over a year by 35% (Hupperets et al., 2009).
Achilles tendinopathy
Heavy slow strength training worked as well as eccentrics
Both heavy slow resistance and eccentric training improved Achilles pain and function over a year, and people stuck with the heavy slow program more consistently (Beyer et al., 2015).
Achilles rupture
Surgery or not, with trade-offs
Function at 12 months was similar with or without surgery. Rerupture was more common without surgery, and nerve injury more common with it (Myhrvold et al., 2022).
Most ankle injuries recover with the right load at the right time, and the strength and balance you rebuild help protect against the next one. That is why we measure your strength and build your plan around it.
Fees and funding
Consultations and Rebates
Every consultation is 45 minutes. The number of consultations you need depends on your ankle and your goals, so we discuss your plan with you at your first visit.
Book an AppointmentWays to claim
- Private health: rebates claimed on the spot with HICAPS
- Medicare: rebates with a GP referral
- Workers compensation: fees set by SIRA, with approvals coordinated with your case manager
- CTP: fees set by SIRA
Common Questions
Do I need an X-ray for my ankle?
Not always. The Ottawa ankle rules, a short set of checks on where the bone is tender and whether you can take four steps, reliably rule out a fracture, and using them could avoid 30 to 40% of ankle X-rays (Bachmann et al., 2003). If you do need one, we arrange it through your GP or a sports physician.
Should I rest or keep moving after an ankle sprain?
A short period of protection can ease pain and swelling, but most sprains recover best with early movement and an exercise-based plan, with tape or a brace if needed (Vuurberg et al., 2018). We help you judge how much to do and when.
Should I wear a brace or tape for sport?
For many people returning to sport after a sprain, a brace or tape is a reasonable option while you rebuild, and braces are recommended for preventing recurrent sprains (Vuurberg et al., 2018). Balance training matters too: it reduced repeat sprains by 35% over a year (Hupperets et al., 2009).
Do I need surgery for an Achilles rupture?
Not everyone does. In a trial of 554 adults, function at 12 months was similar with and without surgery, with a higher rerupture rate without surgery and more nerve injuries with it (Myhrvold et al., 2022). The decision depends on your goals and your doctor's or surgeon's advice, and the rehabilitation that follows matters either way.
Should I get a PRP injection for Achilles pain?
It is a decision for you and your doctor. In a large trial, a PRP injection gave no better tendon function at 6 months than a placebo injection (Kearney et al., 2021). We are happy to talk it through with you and your GP or specialist.
When should I see a doctor urgently?
Seek urgent medical care if you cannot put weight on your leg after an injury, if your ankle looks deformed or your foot is numb or cold, or if your calf is swollen, hot and painful without an injury. If you felt a snap or a kick at the back of your ankle, have it assessed promptly, as early treatment of an Achilles rupture matters.
How many sessions will I need?
It depends on your ankle, how long you have had symptoms and your goals. We give you an estimate at your first visit and review it as you meet each step's goal.
Can I claim my physio through private health?
Yes. Rebates are claimed on the spot with HICAPS. Medicare rebates are available with a GP referral, and workers compensation and CTP claims are accepted once approved.
What research is this page based on?
The studies referenced on this page are listed below.
- Bachmann LM, Kolb E, Koller MT, Steurer J, ter Riet G. Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review. BMJ. 2003;326(7386):417.
- Beyer R, Kongsgaard M, Hougs Kjær B, Øhlenschlæger T, Kjær M, Magnusson SP. Heavy slow resistance versus eccentric training as treatment for Achilles tendinopathy: a randomized controlled trial. Am J Sports Med. 2015;43(7):1704–1711.
- Doherty C, Bleakley C, Hertel J, Caulfield B, Ryan J, Delahunt E. Recovery from a first-time lateral ankle sprain and the predictors of chronic ankle instability: a prospective cohort analysis. Am J Sports Med. 2016;44(4):995–1003.
- Hupperets MDW, Verhagen EALM, van Mechelen W. Effect of unsupervised home based proprioceptive training on recurrences of ankle sprain: randomised controlled trial. BMJ. 2009;339:b2684.
- Kearney RS, Ji C, Warwick J, Parsons N, Brown J, Harrison P, Young J, Costa ML. Effect of platelet-rich plasma injection vs sham injection on tendon dysfunction in patients with chronic midportion Achilles tendinopathy: a randomized clinical trial. JAMA. 2021;326(2):137–144.
- Myhrvold SB, Brouwer EF, Andresen TKM, Rydevik K, Amundsen M, Grün W, Butt F, Valberg M, Ulstein S, Hoelsbrekken SE. Nonoperative or surgical treatment of acute Achilles’ tendon rupture. N Engl J Med. 2022;386(15):1409–1420.
- Vuurberg G, Hoorntje A, Wink LM, van der Doelen BFW, van den Bekerom MP, Dekker R, van Dijk CN, Krips R, Loogman MCM, Ridderikhof ML, Smithuis FF, Stufkens SAS, Verhagen EALM, de Bie RA, Kerkhoffs GMMJ. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. Br J Sports Med. 2018;52(15):956–970.
- Clinically reviewed by David Cohen and Zachary Ehrenfeld, APA Musculoskeletal Physiotherapists and Directors of Vantage Point Physiotherapy. Last reviewed October 2026.
