The pain and stiffness of arthritis and other foot and ankle conditions can be debilitating. Around 25% of the bones in the body are in the feet and ankles. The average person walks about 100,000 miles during his/her lifetime, so no wonder foot and ankle pain is common. In addition, 20 million people are affected by some type of arthritis. Here are the top 10 nonoperative foot and ankle pain treatments.
Special Shoes
For patients who have foot deformities, pain, and stiffness, special shoes can be developed. If the toes have begun to stiffen or curl, shoes with an extra deep tow box will help. A soft arch support and a rigid heel can relieve some types of foot pain.
Well-Padded Splint
When the talus bone of the foot becomes fractured, it often does not heal properly, which can affect ankle and foot function later on. A talus fracture can cause bone collapse and chronic arthritis. A well-padded splint will help, which is applied around the back of the leg and foot from the toe to the upper calf.
Orthotics
These devices include shoe inserts, ankle braces, and foot pads. Shoe inserts are placed inside the shoe to alleviate flat feet and pain related to arthritis. Ankle braces can be worn to offer support to weak ankle joints. Food pads are placed on the shoe sole, and they alleviate pain related to arthritic conditions.
Plantar Wart Removal
Some foot pain is related to plantar warts, which occur on the bottoms of the foot. The doctor can apply a strong chemical to remove the warts, or use cryotherapy to freeze them. After treatment, the wart will often resolve within 2-3 weeks.
Short Leg Casts and Walking Boots
For patients with posterior tibial tendonitis, a walking boot or short leg cast can be used. The goal of these devices is to rest the lower leg and decrease inflammation. The boot or cast provides a stiff platform for the foot and limits motion between the rear foot and mid foot.
Medications
For foot and ankle pain, commonly prescribed medications include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) – These drugs reduce inflammation to ease pain. Examples include ibuprofen and ketoprofen.
- Corticosteroids – These drugs are used short-term to alleviate inflammation due to systematic inflammatory disease, such as rheumatoid arthritis.
- Analgesics – For serious pain, opioids can be prescribed to relieve discomfort. Many topical agents can help, such as Capzasin, Aspercreme, and Voltaren gel.
- Disease modifying anti-rheumatic drugs (DMARDs) – These drugs are used to treat psoriatic arthritis, rheumatoid arthritis, and lupus, which all affect the small joints of the feet and ankles.
- Gout medications – To reduce levels of uric acid and prevent joint pain and inflammation, gout medications may be taken.
Physical Therapy
The physical therapist uses various techniques to improve foot and ankle pain, such as tilt-board exercises and strengthening exercises. This restores range of motion and improves perception of joint position.
Steroid Injections
A steroid can be injected into the foot/ankle joint to reduce swelling, improve joint function, and alleviate pain. During the procedure, the skin over the joint is cleaned with a topical solution, and a local anesthetic is used to numb the area. X-ray guidance is used to assure correct needle placement. The joint is injected with a corticosteroid with or without an anesthetic.
Extracorporeal Shock Wave Therapy
Shock wave therapy is a noninvasive therapy used to relieve pain associated with Achilles tendonitis (degenerated tendons) and plantar fasciitis (heel pain). This involves use of high-energy acoustic waves that deliver a mechanical force to the body’s tissues. The shock waves create a force that induces healing of the tissues. A probes is placed on the skin to conduct the high- and low-energy energy waves.
Epidural Steroid Injection
Some patients with spinal disease have radicular pain, which radiates down to one foot or both feet. The doctor can inject the epidural space (which lies outside the spinal cord) with a steroidal agent. This decreases nerve root inflammation and relieves pain. In a recent study, patients reported more than 50% reduction in pain following an epidural steroid injection. This procedure has an 88% success rate.