Skip to main content Accessibility help
×
Hostname: page-component-78c5997874-g7gxr Total loading time: 0 Render date: 2024-11-10T16:29:31.916Z Has data issue: false hasContentIssue false

Chapter 23 - Chronic Ankle and Foot Pain

from Part V - Extremities

Published online by Cambridge University Press:  01 December 2023

Omar Viswanath
Affiliation:
Creighton University, Omaha
Ivan Urits
Affiliation:
Southcoast Brain & Spine Center, Wareham
Get access

Summary

Chronic foot and ankle pain is a common symptom of a wide variety of conditions. Nationwide burden of substantial foot or ankle pain is 24% and 15%, respectively, resulting in a significant healthcare burden. Certain conditions have more specific etiologies or risk factors, many origins of chronic pain lie in obesity, lack of exercise/foot strength, and poor foot biomechanics. Chronic repetitive damage to the surrounding ligaments of the ankle joint structure or repetitive damage to the synovial joint itself can lead to CAI and osteoarthritis, respectively. Systemic disease, acute and overuse injuries, and anatomical deformities must also be considered when evaluating for the origin of pain. For many conditions, conservative treatment with oral anti-inflammatory drugs, orthotics, and physical therapy are first-line treatment and mitigate symptoms effectively in a majority of compliant patients. There is good evidence for the use of various modalities of pharmaceutical injections before recommending a patient to a more invasive surgical procedure.

Type
Chapter
Information
Publisher: Cambridge University Press
Print publication year: 2023

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Thomas, MJ, Roddy, E, Zhang, W et al. The population prevalence of foot and ankle pain in middle and old age: A systematic review. Pain. 2011;152(12):28702880.CrossRefGoogle ScholarPubMed
Menz, HB, Dufour, AB, Casey, VA et al. Foot pain and mobility limitations in older adults: The Framingham foot study. J Gerontol A Biol Sci Med Sci. 2013;68(10):12811285.CrossRefGoogle ScholarPubMed
Belatti, DA, Phisitkul, P. Economic burden of foot and ankle surgery in the US Medicare population. Foot Ankle Int. 2014;35(4):334340.CrossRefGoogle ScholarPubMed
Werner, RA, Gell, N, Hartigan, A, Wiggermann, N, Keyserling, WM. Risk factors for foot and ankle disorders among assembly plant workers. Am J Ind Med. 2010;53(12):12331239.CrossRefGoogle ScholarPubMed
Oh-Park, M, Kirschner, J, Abdelshahed, D, Kim, DDJ. Painful foot disorders in the geriatric population: A narrative review. Am J Phys Med Rehabil. 2019;98(9):811819.CrossRefGoogle ScholarPubMed
Yong, RJ, Mullins, PM, Bhattacharyya, N. Prevalence of chronic pain among adults in the United States. Pain. 2022;163(2):e328e332.CrossRefGoogle ScholarPubMed
Gribble, PA. Evaluating and differentiating ankle instability. J Athl Train. 2019;54(6):617627.CrossRefGoogle ScholarPubMed
Miklovic, TM, Donovan, L, Protzuk, OA, Kang, MS, Feger, MA. Acute lateral ankle sprain to chronic ankle instability: A pathway of dysfunction. Phys Sportsmed. 2018;46(1):116122.CrossRefGoogle ScholarPubMed
Czajka, CM, Tran, E, Cai, AN, DiPreta, JA. Ankle sprains and instability. Med Clin North Am. 2014;98(2):313329.CrossRefGoogle ScholarPubMed
Urits, I, Smoots, D, Franscioni, H et al. Injection techniques for common chronic pain conditions of the foot: A comprehensive review. Pain Ther. 2020;9(1):145160.CrossRefGoogle ScholarPubMed
van der Merwe, C, Shultz, SP, Colborne, GR, Fink, PW. Foot muscle strengthening and lower limb injury prevention. Res Q Exerc Sport. 2021;92(3):380387.CrossRefGoogle ScholarPubMed
Urits, I, Hasegawa, M, Orhurhu, V et al. Minimally invasive treatment of chronic ankle instability: A comprehensive review. Curr Pain Headache Rep. 2020;24(3): 1040–1048. doi: 10.1007/s00167-016-4041-1.CrossRefGoogle ScholarPubMed
Khlopas, H, Khlopas, A, Samuel, LT et al. Current concepts in osteoarthritis of the ankle: Review. Surg Technol Int. 2019;35:280294.Google ScholarPubMed
Pietramaggiori, G, Sapino, G, De Santis, G, Bassetto, F, Scherer, S. Chronic knee and ankle pain treatment through selective microsurgical approaches: A minimally invasive option in the treatment algorithm for refractory lower limb pain. J Reconstr Microsurg. 2021;37(3):234241.Google ScholarPubMed
Arroyo-Hernández, M, Mellado-Romero, M, Páramo-Díaz, P, García-Lamas, L, Vilà-Rico, J. Chronic ankle instability: Arthroscopic anatomical repair. Rev Esp Cir Ortop Traumatol. 2017;61(2):104110.Google ScholarPubMed
Di Caprio, F, Meringolo, R, Shehab Eddine, M, Ponziani, L. Morton’s interdigital neuroma of the foot: A literature review. Foot Ankle Surg. 2018;24(2):9298.CrossRefGoogle ScholarPubMed
Longo, UG, Ronga, M, Maffulli, N. Achilles tendinopathy. Sports Med Arthrosc Rev. 2018;26(1):1630.CrossRefGoogle ScholarPubMed
McSweeney, SC, Cichero, M. Tarsal tunnel syndrome: A narrative literature review. Foot (Edinb). 2015;25(4):244250.CrossRefGoogle ScholarPubMed
Kuo, CF, Grainge, MJ, Zhang, W, Doherty, M. Global epidemiology of gout: Prevalence, incidence and risk factors. Nat Rev Rheumatol. 2015;11(11):649662.CrossRefGoogle ScholarPubMed
Evans, PL, Prior, JA, Belcher, J et al. Obesity, hypertension and diuretic use as risk factors for incident gout: A systematic review and meta-analysis of cohort studies. Arthritis Res Ther. 2018;20(1):136. doi: 10.1186/s13075-018-1612-1.CrossRefGoogle Scholar
Al-Mohrej, OA, Al-Kenani, NS. Chronic ankle instability: Current perspectives. Avicenna J Med. 2016;6(4):103108.Google ScholarPubMed
Gougoulias, N, Lampridis, V, Sakellariou, A. Morton’s interdigital neuroma: Instructional review. EFORT Open Rev. 2019;4(1):1424.CrossRefGoogle ScholarPubMed
Kader, D, Saxena, A, Movin, T, Maffulli, N. Achilles tendinopathy: Some aspects of basic science and clinical management. Br J Sports Med. 2002;36(4):239249.CrossRefGoogle ScholarPubMed
Ragab, G, Elshahaly, M, Bardin, T. Gout: An old disease in new perspective: A review. J Adv Res. 2017;8(5):495511.CrossRefGoogle ScholarPubMed
Paterson, KL, Gates, L. Clinical assessment and management of foot and ankle osteoarthritis: A review of current evidence and focus on pharmacological treatment. Drugs Aging. 2019;36(3):203211.CrossRefGoogle ScholarPubMed
Aletaha, D, Neogi, T, Silman, AJ et al. Rheumatoid arthritis classification criteria: An American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010;62(9):25692581.CrossRefGoogle ScholarPubMed
Gribble, PA, Delahunt, E, Bleakley, CM et al. Selection criteria for patients with chronic ankle instability in controlled research: A position statement of the International Ankle Consortium. J Athl Train. 2014;49(1):121127.CrossRefGoogle ScholarPubMed
Weinfeld, SB. Achilles tendon disorders. Med Clin North Am. 2014;98(2):331338.CrossRefGoogle ScholarPubMed
Zellers, JA, Bley, BC, Pohlig, RT, Alghamdi, NH, Silbernagel, KG. Frequency of pathology on diagnostic ultrasound and relationship to patient demographics in individuals with insertional Achilles tendinopathy. Int J Sports Phys Ther. 2019;14(5):761769.CrossRefGoogle ScholarPubMed
Antoniadis, G, Scheglmann, K. Posterior tarsal tunnel syndrome diagnosis and treatment. Dtsch Arztebl. 2008;105(45):776781.Google ScholarPubMed
Rinkel, WD, Cabezas, MC, Van Neck, JW et al. Validity of the Tinel sign and prevalence of tibial nerve entrapment at the tarsal tunnel in both diabetic and nondiabetic subjects: A cross-sectional study. Plast Reconstr Surg. 2018;142(5):12581266.CrossRefGoogle ScholarPubMed
Roddy, E, Thomas, MJ, Marshall, M et al. The population prevalence of symptomatic radiographic foot osteoarthritis in community-dwelling older adults: Cross-sectional findings from the clinical assessment study of the foot. Ann Rheum Dis. 2015;74(1):156163.CrossRefGoogle ScholarPubMed
Simonsen, MB, Hørslev-Petersen, K, Cöster, MC, Jensen, C, Bremander, A. Foot and ankle problems in patients with rheumatoid arthritis in 2019: Still an important issue. ACR Open Rheumatol. 2021;3(6):396402.CrossRefGoogle ScholarPubMed
Heidari, B. Rheumatoid arthritis: Early diagnosis and treatment outcomes. Caspian J Intern Med. 2011;2(1):161170.Google ScholarPubMed
Gerstner Garces, JB. Chronic ankle instability. Foot Ankle Clin. 2012;17(3):389398.CrossRefGoogle ScholarPubMed
Khan, M, Shanmugaraj, A, Prada, C et al. The role of hyaluronic acid for soft tissue indications: A systematic review and meta-analysis. Sports Health. 2022;15(1):8696. doi: 10.1177/19417381211073316. .CrossRefGoogle ScholarPubMed
Petrella, MJ, Coglian;o, A, Petrella, RJ. Original research: Long-term efficacy and safety of periarticular hyaluronic acid in acute ankle sprain. Phys Sportsmed. 2009;37:6470.CrossRefGoogle ScholarPubMed
Vannini, F, Di Matteo, B, Filardo, G. Platelet-rich plasma to treat ankle cartilage pathology – from translational potential to clinical evidence: A systematic review. J Exp Orthop. 2015;2(1):2. doi: 10.1186/s40634-015-0019-z.CrossRefGoogle ScholarPubMed
Cruz-Díaz, D, Lomas Vega, R, Osuna-Pérez, MC, Hita-Contreras, F, Martínez-Amat, A. Effects of joint mobilization on chronic ankle instability: A randomized controlled trial. Disabil Rehabil. 2015;37(7):601610.CrossRefGoogle ScholarPubMed
Cain, MS, Ban, RJ, Chen, YP et al. Four-week ankle-rehabilitation programs in adolescent athletes with chronic ankle instability. J Athl Train. 2020;55(8):801810.CrossRefGoogle ScholarPubMed
Anguish, B, Sandrey, MA. Two 4-week balance-training programs for chronic ankle instability. J Athl Train. 2018;53(7):662671.CrossRefGoogle ScholarPubMed
Chang, SH, Morris, BL, Saengsin, J et al. Diagnosis and treatment of chronic lateral ankle instability: Review of our biomechanical evidence. J Am Acad Orthop Surg. 2021;29(1):316.CrossRefGoogle ScholarPubMed
Matthews, BG, Hurn, SE, Harding, MP, Henry, RA, Ware, RS. The effectiveness of non-surgical interventions for common plantar digital compressive neuropathy (Morton’s neuroma): A systematic review and meta-analysis. J Foot Ankle Res. 2019;12:12. doi: 10.1186/s13047-019-0320-7.CrossRefGoogle ScholarPubMed
Santos, D, Morrison, G, Coda, A. Sclerosing alcohol injections for the management of intermetatarsal neuromas: A systematic review. Foot (Edinb). 2018;35:3647.CrossRefGoogle ScholarPubMed
Campbell, CM, Diamond, E, Schmidt, WK et al. A randomized, double-blind, placebo-controlled trial of injected capsaicin for pain in Morton’s neuroma. Pain. 2016;157(6):12971304.CrossRefGoogle ScholarPubMed
Lee, K, Hwang, IY, Ryu, CH, Lee, JW, Kang, SW. Ultrasound-guided hyaluronic acid injection for the management of Morton’s neuroma. Foot Ankle Int. 2018;39(2):201204.CrossRefGoogle ScholarPubMed
Zhang, YJ, Xu, SZ, Gu, PC et al. Is platelet-rich plasma injection effective for chronic Achilles tendinopathy? A meta-analysis. Clin Orthop Relat Res. 2018;476(8):16331641.CrossRefGoogle ScholarPubMed
Chen, X, Jones, IA, Park, C, Vangsness, CT Jr. The efficacy of platelet-rich plasma on tendon and ligament healing: A systematic review and meta-analysis with bias assessment. Am J Sports Med. 2018;46(8):20202032.CrossRefGoogle ScholarPubMed
Yelland, MJ, Sweeting, KR, Lyftogt, JA et al. Prolotherapy injections and eccentric loading exercises for painful Achilles tendinosis: A randomised trial. Br J Sports Med. 2011;45(5):421428.CrossRefGoogle ScholarPubMed
Ferkel, E, Davis, WH, Ellington, JK. Entrapment neuropathies of the foot and ankle. Clin Sports Med. 2015;34(4):791801.CrossRefGoogle ScholarPubMed
Tu, P. Heel pain: Diagnosis and management. Am Fam Physician. 2018;97(2):8693.Google ScholarPubMed
Choo, YJ, Park, CH, Chang, MC. Rearfoot disorders and conservative treatment: A narrative review. Ann Palliat Med. 2020;9(5):35463552.CrossRefGoogle ScholarPubMed
Vij, N, Kaley, HN, Robinson, CL et al. Clinical results following conservative management of tarsal tunnel syndrome compared with surgical treatment: A systematic review. Orthop Rev (Pavia). 2022;14(3):37539. doi: 10.52965/001c.37539.CrossRefGoogle ScholarPubMed
Kang, MH, Moon, KW, Jeon, YH, Cho, SW. Sonography of the first metatarsophalangeal joint and sonographically guided intraarticular injection of corticosteroid in acute gout attack. J Clin Ultrasound. 2015;43(3):179186.CrossRefGoogle ScholarPubMed
Fernández, C, Noguera, R, González, JA, Pascual, E. Treatment of acute attacks of gout with a small dose of intraarticular triamcinolone acetonide. J Rheumatol. 1999;26(10):22852286.Google ScholarPubMed
Wechalekar, MD, Vinik, O, Moi, JH et al. The efficacy and safety of treatments for acute gout: Results from a series of systematic literature reviews including Cochrane reviews on intraarticular glucocorticoids, colchicine, nonsteroidal antiinflammatory drugs, and interleukin-1 inhibitors. J Rheumatol Suppl. 2014;92:1525.CrossRefGoogle ScholarPubMed
Richette, P, Doherty, M, Pascual, E et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis. 2017;76(1):2942.CrossRefGoogle ScholarPubMed
Wechalekar, MD, Vinik, O, Schlesinger, N, Buchbinder, R. Intra-articular glucocorticoids for acute gout. Cochrane Database Syst Rev. 2013;(4):CD009920. doi: 10.1002/14651858.CD009920.pub2.Google ScholarPubMed
Roddy, E, Menz, HB. Foot osteoarthritis: Latest evidence and developments. Therap Adv Musculoskelet Dis. 2018;10:91103.CrossRefGoogle ScholarPubMed
Drakonaki, EE, Kho, JSB, Sharp, RJ, Ostlere, SJ. Efficacy of ultrasound-guided steroid injections for pain management of midfoot joint degenerative disease. Skelet Radiol. 2011;40(8):10011006.CrossRefGoogle ScholarPubMed
Protheroe, D, Gadgil, A. Guided intra-articular corticosteroid injections in the midfoot. Foot Ankle Int. 2018;39(8):10011004.CrossRefGoogle ScholarPubMed
Grice, J, Marsland, D, Smith, G, Calder, J. Efficacy of foot and ankle corticosteroid injections. Foot Ankle Int. 2017;38(1):813.CrossRefGoogle ScholarPubMed
Pons, M, Alvarez, F, Solana, J, Viladot, R, Varela, L. Sodium hyaluronate in the treatment of hallux rigidus. A single-blind, randomized study. Foot ankle Int. 2007;28(1):3842.CrossRefGoogle ScholarPubMed
Vannabouathong, C, Del Fabbro, G, Sales, B et al. Intra-articular injections in the treatment of symptoms from ankle arthritis: A systematic review. Foot Ankle Int. 2018;39(10):11411150.CrossRefGoogle ScholarPubMed
Fukawa, T, Yamaguchi, S, Akatsu, Y et al. Safety and efficacy of intra-articular injection of platelet-rich plasma in patients with ankle osteoarthritis. Foot Ankle Int. 2017;38(6):596604.CrossRefGoogle ScholarPubMed
Repetto, I, Biti, B, Cerruti, P, Trentini, R, Felli, L. Conservative treatment of ankle osteoarthritis: Can platelet-rich plasma effectively postpone surgery? J Foot Ankle Surg. 2017;56(2):362365.CrossRefGoogle ScholarPubMed
Emadedin, M, Ghorbani Liastani, M, Fazeli, R et al. Long-term follow-up of intra-articular injection of autologous mesenchymal stem cells in patients with knee, ankle, or hip osteoarthritis. Arch Iran Med. 2015;18(6):336344.Google ScholarPubMed
Lopes, RV, Furtado, RNV, Parmigiani, L et al. Accuracy of intra-articular injections in peripheral joints performed blindly in patients with rheumatoid arthritis. Rheumatology. 2008;47(12):17921794.CrossRefGoogle ScholarPubMed
Cunnington, J, Marshall, N, Hide, G et al. A randomized, double-blind, controlled study of ultrasound-guided corticosteroid injection into the joint of patients with inflammatory arthritis. Arthritis Rheum. 2010;62(7):18621869.CrossRefGoogle ScholarPubMed
Furtado, RNV, Machado, FS, da Luz, KR et al. Intra-articular injection with triamcinolone hexacetonide in patients with rheumatoid arthritis: Prospective assessment of goniometry and joint inflammation parameters. Rev Bras Reumatol (English Ed.). 2017;57(2):115121.CrossRefGoogle ScholarPubMed
Mortada, MA, Abdelwhab, SM, Elgawish, MH. Intra-articular methotrexate versus corticosteroid injections in medium-sized joints of rheumatoid arthritis patients: An intervention study. Clin Rheumatol. 2018;37(2):331337.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×