Interest in rock climbing has grown dramatically over the past decade. Although considerable research has been conducted on upper-extremity injuries sustained during rock climbing, there has been no comprehensive evaluation of lower-extremity injuries and related biomechanics. The authors performed a retrospective investigation of rock-climbing injuries using a survey of 104 active rock climbers of varying levels of expertise. The results show that 81% of the respondents have suffered acute or chronic pain or associated pathology in the foot or ankle during or after climbing. The authors propose that this morbidity has biomechanical etiologies related to the common practice among rock climbers of wearing climbing shoes that are smaller than their street shoes.