Definition and Overview

Foot or ankle pain is a common symptom of injuries (such as ankle sprains and fractures) or diseases affecting the foot (such as arthritis, gout, tarsal tunnel syndrome, infection, and tendonitis).

A patient suffering from foot or ankle pain may seek the advice of a general physician, orthopedists, or bone and joint specialists, who can provide treatment in the form of medication, therapy, or surgery, depending on the cause and severity of the problem.

Causes of Condition

Foot or ankle pain can be caused by several factors, including but not limited to the following:


Disease:

  • Osteoarthritis – This is a degenerative disease that commonly affects the foot and ankle area as well as joints such as the knees, hips, and hands. It is characterized by worn down cartilage tissues due to repetitive motions that cause the bones to constantly rub against each other.
  • Rheumatoid arthritis – This is an autoimmune disease wherein the body’s immune system begins attacking the cells of the synovia or the lubricant that allows smooth joint movements. Thus, every time the joint moves, the patient feels extreme pain.
  • Tendinitis – This is a disease that affects the tendons, which are thick cords that attach the muscles and bones. It is characterized by irritated or inflamed tendons, which cause pain and limited movement.
  • Gout – This is a common form of arthritis that is aggravated by excessively high levels of uric acid in the blood. This disease is characterized by the formation of urate crystals that accumulate in the joints.
  • Bursitis – This is a disease characterized by the inflammation of the bursae, a sac-like protective layer that prevents friction and pain when the muscles and tendons meet the bones.
    Injury:

  • Ankle sprain – This is a type of injury in which the ligaments of the ankle become stretched beyond their normal limit.

  • Ankle strain – This is an injury characterized by tears of the muscle in the ankle typically due to trauma, overexertion, or normal wear and tear.
  • Tenosynovitis – Also known as tendon sheath inflammation, this condition affects the synovium, the protective lubricant that allows the tendons to move with ease. It most commonly occurs as a result of an injury.
  • Fracture – This is a serious injury that qualifies as a medical emergency. A patient who suffers a fracture should receive immediate medical attention. It is characterized by a broken bone, commonly due to trauma or excessive force that is beyond the bone’s natural capacity to bear. Fractures occur in different severity levels, the most severe of which is an open fracture wherein the ends of the broken bone poke through the patient’s skin, causing an open wound.

Key Symptoms

Foot or ankle pain can range from mild to severe, depending on the cause. The pain can be constant or may resolve at rest and reoccur when the foot bears some weight, such as when the patient is standing or walking. It can also be a sharp, piercing pain or a dull ache.

The pain can also be accompanied by other symptoms, such as:

  • Swelling/inflammation
  • Redness
  • Limited range of motion
    The type of pain, its exact location, and other accompanying symptoms will help doctors determine the exact cause. To make or confirm a diagnosis, doctors typically order diagnostic tests, such as:

  • Physical exam

  • CT scan
  • MRI scan
  • X-rays

Who to See and Types of Treatments Available

A person who is experiencing foot or ankle pain can seek the help of a general physician, who may check for other symptoms to determine the cause of the problem. If there is an underlying disease that causes the pain, the general physician may recommend treatment for the said disease. However, if the pain is orthopedic in nature, the general physician will refer the patient to an orthopedist or a bone and joint specialist.

The goals of treatment in managing foot or ankle pain are:

  • To apply first aid when necessary, as in the case of injury
  • To relieve the pain and other symptoms
  • To treat the main cause
  • To restore normal function and full range of motion
    Pain can be relieved using medications, such as non-steroidal inflammatory drugs or NSAIDs, which are taken orally, or cortisone injections, which are taken intravenously.

The main treatment method, however, differs depending on the cause of the pain. In mild cases, such as a minor sprain, the pain may resolve on its own after 24 hours. More severe cases, on the other hand, will require treatment.

Non-surgical treatment methods include:

  • Arch support
  • Braces or canes
  • Custom orthotics
  • Customized footwear
  • Exercise
  • Ice
  • Medications
  • Resting the affected foot or ankle
  • Steroid injections
    Surgical treatment, on the other hand, involves joint fusion or joint replacement. Joint fusion, also known as arthrodesis, is a surgical procedure wherein the bones or joints of the foot or ankle are fused together using screws, plates, and rods. Joint replacement surgery or ankle replacement surgery involves the use of artificial joint implants.

During and after treatment, the full range of motion of the affected foot or ankle is restored with physical therapy.

References:

  • Abu-Laban RV, Rose NGW. Ankle and foot. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Mosby; 2013:chap 58.

  • Irwin TA. Tendon injuries of the foot and ankle. In: Miller MD, Thompson SR, eds. DeLee and Drez's Orthopaedic Sports Medicine. 4th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 117.

  • Koenig MD. Ligament injuries. In: DeLee JC, Drez D Jr, Miller MD, eds. DeLee and Drez's Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2009:section C.

  • Baer GS, Keene JS. Tendon injuries of the foot and ankle. In: DeLee JC, Drez D Jr, Miller MD, eds. DeLee and Drez's Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2009:section D.  

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