Brief Outline of Ankle Pronation

Pronation is the inward rotation of the foot during walking or running. While some pronation is natural and part of the normal gait, excessive pronation can lead to some chronic injuries, and acute over-pronation can lead to strains or sprains.

Ankle Pronation

Anatomy and physiology

The ankle is a hinge joint and is formed of the seven tarsal bones. The two largest tarsals carry the body weight: the calcaneus, or the heel bone, and the heel bone, and the talus, which lies between the tibia and the calcaneus. The tibia and fibula rest on top of the talus. Pronation occurs at the subtalar joint. The strong ligaments of the ankle help provide support and prevent excessive pronation. The muscles of the calf and the anterior muscles of the lower leg also offer support. When these ligaments are loose or the muscles fatigue, the support is lost, which results in more pronation. This causes the arch of the foot to flatten out, which in turn further stretches the ligaments. Also, during weight bearing at midstance, there is a tendency for calcaneal eversion and foot abduction, as the foot moves into dorsiflexion.

Cause of Ankle Pronation

Loose or torn tendons from previous ankle injuries. Weak or fatigued muscles of the lower leg. Improper or worm footwear. Uneven running (or landing) surfaces.

Signs and symptoms

Pain in the arch, heel, and/or knees and hips. Pain during the landing phase of running or jumping. Visible inward rolling of the foot and ankle. Instability in the ankle. Pain may be immediate for acute over-pronation, such as an ankle sprain, or gradual for chronic pronation disorders.

Complications if left unattended

Pronation has been attributed to shin splints, plantar fasciitis, chondromalacia patelle, tendinitis, and even stress fractures. The longer pronation continues, the more the ligaments of the foot and ankle will be stretched, leading to ankle instability. The arches may flatten out and lead to other problems of the foot. Chronic pronation of the foot beyond normal ranges can lead to overuse and chronic injuries.


Rest, ice and anti-inflammatory medications may help alleviate pain. For acute injuries, immobilisation and reduction of weight bearing activities may be required. For chronic injuries, seek the help of a qualifed orthopaedic specialist to help identify and correct the problem.

Rehabilitation and prevention

Correct the underlying problem, e.g. if due to the running surface, change the surface to one that is flat and smooth. If due to footwear, try some new or different shoes. If necessary, use orthotics and gait training. Warm-up properly. Stretching and strengthening will offer support and keep the muscles of the lower leg strong and flexible. Completely rehabilitate any ankle injury before returning to sport to prevent any re-occurence.

Long-term prognosis

Will usually respond well to treatment, although the longer pronation goes untreated and allowed to cause damage to the ligaments, the longer the recovery time. In very rare cases, surgical intervention may be required to correct any underlying orthopaedic issues.

Call (+65) 6471 2674 (24 Hour) to fix an appointment to see our doctor to treat ankle pronation today.

Ankle SupinationBrief Outline of Ankle Supination

Supination is the outward rolling of the foot at the ankle. This is a normal movement during the push-off phase of running, walking, or jumping. Excessive supination can cause damage to the ligaments, tendons, and muscles of the lower leg. Acute over-supination may cause stretching or tearing of the ligaments of the foot and ankle. Excessive supination can lead to a weakening of the ankle structure and decreased stability.


Anatomy and physiology

Supination involves the bones of the ankle joint, but more specifically, the subtalar joint. The distal (lower) ends of the tibia and fibula rest on the talus of the foot and allow for movement of the foot. This is traditionally referred to as a hinge joint because its main function is to allow flexion and extension of the foot. It does, however, allow limited pronation and supination as well, which is normal during running, walking, and jumping. These movements aid balance and improve shock absorption.

Cause of Ankle Supination

Weak or loose tendons and ligaments in the ankle. Weak or fatigued muscles of the lower leg. Forceful outward rolling of the ankle. Improper or worn footwear. Uneven or sloped running (or landing) surface.

Signs and symptoms

Pain in the arch, heel, and/or knees and hips. Instability in the ankle. Pain over the outside of the ankle. Pain may be immediate with acute over-supination (such as an ankle sprain).

Complications if left unattended

May lead to chronic weakness and instability to the ankle. The pain and improper gait may lead to compensation and injury to other structures and tissues. The ligaments may loose their elasticity from excessive stretching, and tearing may occur.


Rest, ice, and anti-inflammatory medications to help alleviate the pain. Acute over-supination may require medical attention and immobilisation. Chronic supination will require correction of the underlying problems, whilst allowing adequate rest for the tissues to recover.

Rehabilitation and prevention

Proper warm-up is essential. Strengthening and stretching of the muscles of the lower leg may help support the ankle, keep it moving in the correct plane, and reduce excessive supination. Orthotics and gait analysis may be required. Gradual return to a full workload is recommended and retraining of the athlete to improve, or correct running form is important. Ensure proper footwear and a smooth flat running (or landing) surface.

Long-term prognosis

Will respond well if treated early with a good rehabilitation plan. The length of time the condition is allowed to persist will also affect the recovery time. In rare cases, surgery may be required to tighten the tendons or correct skeletal factors.

Call (+65) 6471 2674 (24 Hour) to fix an appointment to treat your ankle supination today.

Brief Outline of Ankle Sprain

Anyone involved in athletics is susceptible to an ankle sprain, an acute injury to any or all of the ligaments that support the ankle structure. Tearing or stretching of the ligaments can occur when the foot is rolled either medially or laterally, or twisted forcefully. High impact sports involving jumping, sprinting or running on changing or uneven surfaces often lead to ankle sprains. Basketball, football, cross country, and hockey are a few of the sports commonly associated with ankle sprains.

Anatomy and physiology

Lateral ankle sprains commonly occur when stress is applied to the ankle during plantar flexion and inversion, injuring the anterior talofibular ligament. The medial malleolus may act as a fulcrum to further invert the calcaneofibular ligament if the strain continues. The peroneal tendons may absorb some of this strain. Medial ankle sprains are less common, because of the strong deltoid ligament and bony structure of the ankle. The ligaments are stretched beyond their normal range and some tearing of the fibres may occur. Forceful twisting or rolling of the ankle, as with landing on the outside of the foot, can stretch the ligaments past their stretch point.

Cause of Ankle Sprain

Sudden twisting of the foot. Rolling or force to the foot, most commonly laterally.

Signs and symptoms

First-degree sprains: Result in little or no swelling, mild pain, and stiffness in the joint.

Second-degress sprains: Commonly exhibit more swelling and stiffness, moderate to severe pain, difficulty with weight bearing, and some instability in the joint.

Third-degree sprains: Result in severe swelling and pain, inability to bear weight, instability in the joint, and loss of function in the joint.


Complications if left unattended

Chronic pain and instability in the ankle joint may result if left unattended. Loss of strength and flexibility, and possible loss of of function may also result. Re-injuring the joint is much more likely as well.


  • Ice
  • Second- and third-degree sprains may require immobilisation
  • Third-degreee sprains may require surgery

Rehabilitation and prevention

Strengthening the muscles of the lower leg is important to prevent future sprains. Balance activities will help to increase proprioception (the body’s awareness of movement and position of the body), and strengthen the weakened ligaments. Flexibility exercises to reduce stiffness and improve mobility are needed also. Bracing during the initial return to activity may be needed but should not replace strengthening and flexibility development.

Long-term prognosis

With proper rehabilitation and strengthening, the athlete should not experience any limitations. A slight increase in the probability of injuring that ankle may occur. Athletes who continue to experience difficulty with the ankle may need additional medical interventions, including, in rare cases, possible surgery to tighten the ligaments.

Call (+65) 6471 2674 for an appointment to see our doctor to treat ankle sprain today.


Achilles tendinitis is a syndrome of irritation of the Achilles tendon in the ankle. The Achilles tendon is the large tendon in the back of the ankle that inserts into the heel bone. When individuals overuse their Achilles tendon it becomes irritated and inflamed. This inflammation can cause pain and swelling. Furthermore, this can lead to small tears within the tendon and make the Achilles tendon susceptible to rupture


Achilles tendinitis is most often caused by repetitive, minor impact on the affected area, or from a sudden more serious injury. Incorrect posture at work or home or poor stretching or conditioning before exercise or playing sports also increases the risk.


To prevent Achilles tendinitis, take the activity slow at first and gradually build up the activity level. Use limited force and limited repetitions and stop if unusual pain occurs.


Initial treatment of Achilles tendinitis includes avoiding activities that aggravate the problem, resting the injured area, icing the area the day of the injury and taking over-the-counter anti-inflammatory drugs. If the condition does not improve more advanced treatments is needed. These include corticosteroid injections and physical therapy.

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