Dr. Aditya Yerrapragada on easing foot and ankle pain

Our feet and ankles are incredibly complex. With over 30 bones, 33 joints and more than 100 muscles, tendons, ligaments and soft tissue connections, foot and ankle issues are common.

"In fact, estimates indicate that 1 in 5 people will experience activity-limiting foot and/or ankle pain at some point in their lives," said fellowship-trained orthopedic foot and ankle surgeon Aditya Yerrapragada, MD, with BoulderCentre for Orthopedcs during a free online health lecture. He described the most common foot and ankle conditions and the latest treatments for pain relief—from non-surgical to minimally invasive surgical options.

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Video: Watch "Easing Foot and Ankle Pain"

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Common foot and ankle conditions

Dr. Yerrapragada described the most common causes of foot and ankle pain. These include:

• Arthritis - Arthritis is joint pain and inflammation caused by the thinning and degenerating of cartilage. 
  
  Dr. Yerrapragada explained, “Arthritis has multiple causes; the most common is age-related wear and tear.” He noted that with arthritis, “You will feel a waxing and waning of pain. Some days will be better than others. You may feel better with some rest. It will also feel tender to the touch, and you may notice swelling around the affected joint.”
  
  Arthritis often responds well to anti-inflammatories.  Other causes might be autoimmune conditions, infections or sustaining a fracture or trauma.
   
• Tendinitis - Tendinitis is an inflammation of our tendons (rather than our joints). It’s painful and presents itself with some swelling. 
  
  “Like arthritis, it’s a condition that can result from overuse. Rest and anti-inflammatories can relieve the pain,” said Dr. Yerrapragada. He added, “What is unique about tendinitis is that there may be partial tearing of the tendon. This pain can often be reduced with anti-inflammatories as well.”
  
  Common locations for tendinitis:
  • Peroneal Tendinitis affects the tendons on the outside of your ankle, as they run down to the middle of your foot. This pain is often activity related.
  • Posterior Tibial Tendinitis affects the inside of your foot and ankle. This tendon is responsible for inverting your foot and providing arch support.
  • Achilles Tendinitis affects the achilles tendon that attaches to your heel in the back of your ankle and foot.  
     
• Plantar Fasciitis - Plantar fasciitis is one of the most common issues Dr. Yerrapragada sees at his clinic. He explained, “The band of tissue called the plantar fascia supports the arch of our foot. Overuse of the plantar fascia can cause micro tears and inflammation.”
  
  The pain is felt in either the heel or the arch and is often worse in the morning or with prolonged sitting. Those who are more at risk for plantar fascia are overweight (putting more stress along the bottom of the foot), experience calf tightness, or participate in endurance activities such as running or dancing.
   
• Bunions - A bunion causes a big bump on the inside of the foot just below your big toe. “Bunions,” said Dr. Yerrapragada, “are more common in women because they more commonly wear narrow-toed and high-heeled shoes. However, 70% of cases can be traced to the inheritance of specific genes.” He continued, “When you look at a bunion x-ray, you can see it’s not a growth, but a deviation of the bone as it drifts to the opposite direction. This is a deformity that progresses over time.”
   
• Stress Fractures - Stress fractures are painful, result from overuse and can affect the toes, heel or ankle. The pain and swelling will improve with rest. According to Dr. Yerrapragada, stress fractures can result from low vitamin D, poor nutrition and high impact activities.
   
• Ankle Sprains - “Ankle sprains,” said Dr. Yerrapragada “usually result when we roll or invert our ankle. There will be soft tissue bleeding, bruising and a lot of pain will occur. Depending on the severity, it could take a few days or months to heal. It can mimic a fracture. So, when in doubt, get an x-ray.”
   
• Fractures - Fractures can involve any bone in your ankle or foot and can occur without much trauma. Dr. Yerrapragada noted that there will be severe pain, bruising and swelling, and you will not likely be able to bear weight. Even if you can bear weight, your ankle could still be broken. He stressed that It’s important to obtain an x-ray.

TREATMENT OPTIONS

Nonsurgical Treatment

For any pain or injury, Dr. Yerrapragada recommends starting with “RICE.”

• Rest—is important because many injuries are from overuse.
• Ice—is often more beneficial than heat to reduce inflammation.
• Compression—will help reduce swelling.
• Elevation—is best when you elevate above your heart to reduce swelling and pain.

Beyond “RICE,” to relieve pain and swelling:

• Anti-inflammatories - “We often recommend three weeks of continuous use of a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen (Advil) or naproxen (Aleve). For those who experience stomach upset with these drugs, there is a topical treatment: the generic name is Diclofenac, and the brand name is Voltaren, which was recently approved for over-the-counter use,” explained Dr. Yerrapragada.
   
• Immobilization and orthotics - Immobilizing the foot or ankle with a boot, brace, or cast will reduce pain and enable healing to begin. “In general, you will transition from a boot to a brace. Once you’ve gotten to this phase, you want to be sure you are wearing supportive shoes with thicker soles or that are more rigid, and perhaps have wide toe-box, especially if you have bunions,” said Dr. Yerrapragada. He added, “Over the counter orthotics work well to provide cushion and support. You might need to try different types and, if you do have a unique foot shape, you might look into custom orthotics.”
   
• Physical Therapy - Physical therapy (PT) typically is not recommended until after the mobilization phase is complete. PT can include stretching, strengthening, gait training, dry needling shock or ultrasound wave therapy.
   
• Additional equipment -
  • Heel cups—these help with plantar fasciitis. 
  • Night splints—keeps your ankle at 90 degrees while you sleep to stretch your calf reducing the pain of planta fasciitis.
  • Metatarsal pads—reduce weight on the toes.
  • Toe spacers—can help with bunions.

Surgical Treatment

If non-surgical treatments aren’t providing you with relief, surgery may become an option. 

• Arthritis - Joints can be replaced or fused. For ankles, Dr. Yerrapragada prefers replacement. Arthroscopic surgery is often successful for minor arthritic issues.
   
• Tendinitis - Dr. Yerrapragada explained, “If your tendinitis continues to progress to a tear, we can stitch the tear back together.” He said options to repair achilles tendinitis can be minimally invasive or open. “With a minimally invasive option, we make a small incision in the tendon. This enables us to grab the tendon, pull it down and anchor it to the bone. Alternatively, the surgery may entail opening the tendon to clean out bone spurs and/or degenerative pieces of the tendon. We then use sutures to anchor the tendon back down.” 
   
• Bunions - “Again,” said Dr. Yerrapragada, “bunion surgery can be minimally invasive or open. The minimally invasive options include a few small incisions. Whereas the open option requires a longer incision. Both options may include the placement of pins, screws and/or staples.”
   
• Ankle Sprains - Ankle sprain surgery is typically performed on those who have recurrent issues. With every sprain, the ligament stretches more until it is unable to provide needed stability. “This often require ligament reconstruction, called a Broström procedure, to retighten the ligament.” 
   
• Fractures - According to Dr. Yerrapragada, there are many types of fractures that effect different bones and many types of hardware used to realign the bones and joints. When a bone is displaced, realignment is important. If this is not done, it will likely result in arthritis.

Schedule an Appointment

Call 303.449.2730 or visit BoulderCentre for Orthopedics & Spine to schedule an appointment with Aditya Yerrapragada, MD.

Click here to view/download a PDF of slides shown during the lecture.

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