Under pressure
Our feet and ankles are under a lot of pressure. The average person takes 8,000 to 10,000 steps per day. With each step, each ankle supports about five times a person’s body weight. While running, the pressure on our feet is about three or four times our body weight.
It’s no wonder so many people experience foot and ankle problems.
Foot and ankle injuries top the list when it comes to sports injuries in America. But you don’t have to be an athlete to be part of the club: 75 percent of Americans experience some type of foot pain in their lifetime.
The team of specialized foot and ankle care professionals at the Orthopaedic Associates of Michigan Foot & Ankle Center treat all kinds of foot and ankle pain and problems, but they specialize in complex cases that have been referred by other physicians.
Earlier this month, Robert S. Marsh, DO, specialist with the OAM Foot & Ankle Center, explored a few of the most common types and causes of foot pain, as well as ways to prevent it. In this post, OAM Foot & Ankle Center specialist Donald R. Bohay, MD, FACS, discusses treatments for some of the more common types of foot and ankle problems.
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What are some of the problems that would bring a patient to the Foot & Ankle Center at OAM, and how would they be treated?
“In our practice, we see quite a variety of foot and ankle problems — they range from the simplest things like corns and calluses, all the way to complex deformity as a result of trauma or congenital condition,” says Dr. Bohay. “But one of the most common is plantar fasciitis — we probably see five to 10 patients a day with that diagnosis.”
Treating Plantar Fasciitis
Plantar fasciitis comes on when the ligament that supports the arch of the foot — or the plantar fascia — develops tiny tears and becomes irritated and inflamed.
“We believe the primary source of this problem is tightness of the calf muscle or the gastrocnemius,” explains Dr. Bohay. “We start simply with a stretching program and a night splint. That’s typically a three to six month program and most patients get relief.
“For patients who don’t improve with this type of conservative treatment, we offer an outpatient surgical procedure called a gastrocnemius release,” explains Dr. Bohay. “With this procedure, we’re able to lengthen the gastrocnemius and eliminate the underlying source of the problem.”
Following this procedure, patients wear a walking boot and can expect a recovery period of about two weeks.
Metatarsalgia and stress fractures: similar pain, different treatments
Metatarsalgia and stress fractures are also fairly common foot problems, particularly among runners.
“Runners are a unique subset of our patient population,” says Dr. Bohay. “They typically have symptoms related to overuse or training errors, which can include metatarsalgia, or pain and inflammation in the balls of the feet, and stress fractures — tiny fractures in the metatarsals or toe bones.”
According to Dr. Bohay, the two conditions are sometimes confused, but treatments are different so it’s important to get an accurate diagnosis.
“When a patient has a stress fracture, the pain is primarily on the top of the foot,” says Dr. Bohay. “They’ll describe the symptoms as sharp pain when they walk or run. That is opposed to the patient who describes pain in the balls of their feet and says it feels like they’re walking on balls or marbles. That pain is typical of someone with metatarsalgia.”
An x-ray or other advanced imaging is used to confirm a stress fracture.
“Patients with stress fractures are treated with rest and immobilization for at least six weeks,” says Dr. Bohay. “That may mean a cast or a fracture brace, and possibly crutches.”
Treatment for metatarsalgia is different. “That is primarily treated with an orthotic device with a metatarsal pad,” explains Dr. Bohay. “The metatarsal pad is placed in the orthotic in a way that transfers the weight away from the head of the metatarsal bones, the source of the pain. The patient would wear this orthotic at least as long as they experience discomfort, but it’s likely something they would continue wearing to avoid return of the symptoms.”
RICE is good for ankle injuries
Metatarsalgia and stress fractures aren’t the only problems commonly brought on by running and other activities. Running, contact sports, and ordinary twists and turns can also lead to ankle injuries.
“In young athletes — high school and early college — we see a lot of ankle problems, mostly recurring sprains and strains,” Dr. Bohay points out.
“For the patient with an acute, or fresh, sprain, we recommend the well-known RICE treatment — rest, ice, compression, and elevation. We recommend that with or without a course of physical therapy for most athletes with an ankle sprain.”
As severity or frequency of injuries increases, so does intensity of treatment.
“We’ll step up treatment for athletes who have their sport compromised by their ankle instability, or those who have recurring sprains and strains. They’ll undergo more physical therapy, bracing techniques, and potential modifications in their sporting activity,” explains Dr. Bohay.
“If they don’t improve with conservative treatment and their sports performance continues to be compromised, they become candidates for ankle ligament reconstruction.”
This type of ligament reconstruction isn’t restricted to athletes, according to Dr. Bohay. “We can do the same operation on a 15-year-old football player that we can do on a 75-year-old hunter who, due to recurring ankle injuries, is having trouble walking the trails through the woods.”
But older adults tend to have their own set of problems when it comes to feet and ankles.
Where there are joints, there can be arthritis
Arthritis is a condition of the joints that primarily affects older adults. The feet and ankles contain 33 joints, so it’s no wonder arthritis of the mid-foot and ankle are among the more common diagnoses when someone over 50 is experiencing foot or ankle pain.
“In the middle of the foot, arthritis presents as a standard achy, deep pain that gets worse with activity and may be accompanied by swelling along the top of the foot,” says Dr. Bohay. “Treatment is similar to treatment of arthritis anywhere in the body. It typically includes activity modification, non-steroid anti-inflammatory drugs, modifications in shoes, and, sometimes, an orthotic device.”
But, because type and severity of arthritis can vary dramatically, some patients don’t improve with these more conservative treatments.
“These people become surgical candidates,” says Dr. Bohay. “In the foot, that means a fusion of the affected joints. In this procedure, we remove the arthritis and screw together the affected joint so it grows together and no longer causes arthritis pain.”
Recovery can be long. Patients should expect to wear a cast for eight weeks and an immobilization boot for another four weeks. But they can also expect relief from their pain.
“Ankle arthritis is another problem we see frequently among adults over 50, and it’s typically post-traumatic,” says Dr. Bohay. “These are the people who, when they were in their teens and 20s, had several ankle sprains that may or may not have been treated, or they may have broken their ankle skiing. Now they describe pain with activity and swelling above the ankle.
“Our first course of treatment is the same as is offered for people with mid-foot arthritis: modify activity and footwear and non-steroid anti-inflammatories,” continues Dr. Bohay.
Like those with mid-foot arthritis, patients whose symptoms don’t improve with conservative treatment may be candidates for ankle surgery. Surgery to treat severe ankle arthritis falls into two categories: ankle fusion (called arthrodesis) or ankle replacement.
Dr. Bohay and his colleagues at the OAM Foot & Ankle Center specialize in the most advanced ankle fusion and replacement surgeries.
“There is still much innovation and research happening in the area of total ankle replacements,” says Dr. Bohay. “But we have reached the point where implants routinely improve the quality of life for patients with severe ankle arthritis.”
For more on related foot and ankle research, watch for an upcoming blog post featuring OAM Foot & Ankle Specialist John G. Anderson, MD.