What should I do when my foot or ankle pain won't go away?
Orthopedic surgeon Lorraine Boakye, MD, offers guidance on what to do if foot or ankle pain persists.
Foot and ankle pain is a common source of frustration because it often involves small bones, ligaments, and/or tendons, all of which can heal at unpredictable rates. A little patience is in order. But what can you do when your patience starts to wear thin because your pain doesn't feel like it's gotten any better over time? Lorraine A.T. Boakye, MD, Assistant Professor of Orthopaedic Surgery at Penn Medicine and Director of Clinical Research in the Penn Orthopaedics Foot and Ankle Division, offered some guidance.
What causes foot or ankle pain?
According to Boakye, the most common causes of foot or ankle pain are an injury or overuse. Foot or ankle pain caused by an injury occurs suddenly and includes conditions such as sprains and fractures.
What should I do after a foot or ankle injury?
If your foot or ankle pain is the result of an injury, in the moments immediately following, Boakye recommended treating it with the tried-and-true acronym RICE, which stands for rest, ice, compression, and elevation.
“Try to spend as little time on your feet over the next few days as work and life will allow,” she said.
Light compression and keeping your injured foot or ankle elevated above the level of your heart will help minimize swelling. Boakye explained that a heating pad can make the injury feel better initially, but because it opens blood vessels in the injured area, it can make the inflammation worse. Ice, on the other hand, will constrict the blood vessels, reducing inflammation.
Acetaminophen and ibuprofen can temporarily relieve discomfort. But first, make sure it's safe to take with any medications you've been prescribed or pre-existing medical conditions that you have.
When should I see a doctor for my foot or ankle injury?
Many foot and ankle injuries may be treated at home, but some symptoms require immediate medical attention, according to Boakye. They include:
- A significant deformity. Compare your injured ankle or foot to the other one. If there's a clear difference in appearance, seek medical attention.
- Any large open wounds or significant bleeding
- You're unable to put any weight on your injured foot or ankle
Otherwise, if the pain hasn't lessened after about three to five days of treating your injury at home, Boakye recommended seeing your primary care physician. They may order x-rays and, depending on what the imaging shows, refer you to a specialist.
Managing foot or ankle pain caused by overuse
Foot and ankle pain can develop gradually over time due to overuse, leading to conditions such as Achilles tendinitis and stress fractures.
The hallmark of an overuse foot or ankle injury is an aching pain that comes on gradually. You may start to notice discomfort in the area of the injury during certain activities. Eventually, it will become more persistent. Achilles tendonitis, for example, may be agitated only during runs or long walks initially. Left unchecked, running will become impossible, and simple everyday activities, like making dinner, will feel like they're straining the tendon.
What should I do at the first sign of foot or ankle pain caused by overuse?
Similar to the advice above for an injury, treat the initial pain with RICE and acetaminophen or ibuprofen. In some cases, overuse injuries will heal on their own with at-home treatment and time off from activities that put stress on the injured area.
Exactly how much time off will depend on the type and severity of the injury. In general, you can return to light activity that involves the injured area if you haven't experienced pain there, without the use of ibuprofen or acetaminophen, for a week. If, after another week, you're still pain-free, you can gradually ramp up your intensity. But be honest with your self-assessments. If you feel any discomfort, limit your activity, and continue resting.
When should I see a doctor for my foot or ankle pain caused by overuse?
The vast majority of overuse foot or ankle injuries do not require immediate medical attention. The exception is those that escalate to the point of causing any of the symptoms listed above for an injury that would prompt urgent treatment.
Aside from these instances, the guidance is similar to that of a foot or ankle injury: If the pain hasn't diminished or resolved after about three to five days of treating it at home, see your primary care physician. They will help address your concerns by performing a thorough examination, obtaining x-rays, and initiating a consultation/referral to an orthopaedic foot and ankle specialist.
Why should I consult an orthopaedic surgeon for my foot or ankle pain?
As mentioned earlier, feet and ankles can be finicky. For that very reason, consulting an orthopaedic surgeon like Boakye should be your next step if your primary care physician refers you to a specialist.
“We have a deep understanding of the complex interplay between musculoskeletal pathology and systemic physiology; this allows us to understand the injury in the context of the patient and the unique set of circumstances,” she said.
Orthopaedic surgeons undergo rigorous training. After graduating from medical school, Boakye did a five-year residency at the University of Pittsburgh, followed by a year-long fellowship at Harvard/Brigham and Women's Hospital. Her path, she said, is typical for an orthopaedic surgeon.
In addition to having access to the latest technology, the orthopaedic surgeons at Penn Medicine are often involved in academic research, “so the ways we practice are really rooted in evidence-based medicine,” she said.
The Achilles tendon is the focus of some of Dr. Boakye's current research. She said she's working to “better understand the biochemical changes associated with both tendinopathy and rupture so that we, as clinicians, may refine our current interventions and optimize patient outcomes.”
A collaborative environment enhances this practice.
“There are several expertly trained, experienced, and conscientious physicians within the Foot and Ankle Division at Penn, and we often work together to create the most innovative, patient-specific interventions.”
What can I expect from my first foot or ankle consultation?
When Boakye meets a patient for the first time, she usually has them undergo weightbearing x-rays.
“It can be a very helpful initial screen because it allows us to see how the foot and ankle interact under a physiologic load,” she said. “And it gives us a more dynamic assessment of the extremity's underlying architecture.”
While waiting for the x-rays, she asks about the patient's medical conditions, past injuries, general lifestyle, and what sorts of physical activity they engage in on a regular basis. The responses, along with the x-rays and her own observations during a physical exam, help her develop a more complete understanding of the injury and inform her treatment strategy.
Often, patients will want to know if they did anything that made their foot or ankle more susceptible to injury so that they won't unknowingly cause another injury. They sometimes also ask if this is something that could get better on its own.
What are my foot or ankle pain treatment options?
It's important to know that surgery is not a certainty just because you're seeing an orthopaedic surgeon. In fact, Boakye said many of her patients may never have surgery.
“We start to talk about surgery if it's becoming clear they're not going to get meaningfully better without surgery. But in most cases, there are lots of other treatment options we can try before surgery becomes a consideration.”
Those options include bracing, orthotics, physical therapy, and pain-relieving injections.
Can I expect to make a full recovery?
Just as pain is subjective, Boakye said that “full recovery” is a relative phrase.
“Whenever someone asks me if they're going to make a full recovery, I usually ask what that means to them, because there's a lot of nuance regarding outcomes," she said. "For example, if we're treating a chronic condition, you're likely not starting at 100 percent, and our shared goal may be to achieve a new normal and arrive as close to their baseline as possible.”
To help each patient achieve their desired functional outcome, Boakye and her fellow doctors at Penn Orthopaedics use the unique expertise, technology, and research at their disposal to provide an accurate diagnosis and an effective treatment plan that's tailored to the patient's needs and goals.