In Part I of this series, I discussed medical conditions and issues that weren’t orthopaedic in origin which could cause foot and ankle swelling, and I also alerted you to some of the usually experienced reasons for temporary foot and ankle edema. Today, my focus will be on the most common Orthopaedic reasons for which I see patients for swollen feet and/or ankles, and they are:
- Osteoarthritis
- Gout
- Ligament Sprains and Muscle Strains
- Bursitis
- Torn or Ruptured Tendons
- Bone Fractures
- Rheumatoid or Psoriatic Arthritis
I order x-rays so that I can see if the patient has arthritis, if they have boney defects or spurs, and so that I can tell if the mechanics of their foot are in proper working order. I look to see if the patient has flat feet, bunions, corns or calluses. I watch them walk (if possible) to look for gait abnormalities and I ask the patient a lot of questions about the swelling. I also do a very thorough physical exam of the foot and ankle, calf, and knee to look for problems elsewhere that could impact the foot or ankle.
Because we rely on our feet and ankles for walking, they are a challenge to treat, no matter how simple the problem may be. My goal is to help the patient remain as mobile as possible, while at the same time, helping them heal and recover quickly and fully.
I will almost always start with conservative treatment for osteoarthritis, strains, sprains, or bursitis. That means anti-inflammatory oral medications and injections, splinting or bracing, activity modification, Physical Therapy, the use of ice (early for sprains and strains) and heat (for arthritis) and topical pain rubs at home.
Simple or stress fractures of the foot or ankle can be set and casted in the office and put in a shoe or boot while the fracture heals. A fracture that protrudes out of the skin (compound) or more severe fractures (which may include ligament, tendon, nerve or blood vessel damage) will require surgery to repair and set. Most fractures, regardless of type, will heal within four to eight weeks. Any soft tissue damage may take much longer than that to heal and may require extensive Physical Therapy.
Bursitis occurs when the cushiony, fluid-filled sacs, called bursae, located around each joint, get inflamed. The bursa can swell causing pain and swelling in the foot or ankle or both. Bursitis typically responds well to anti-inflammatory medication, Physical Therapy and activity modification.
Gout is a form of arthritis where crystals of uric acid form in the joint causing inflammation and damage. It is often seen in the big toe, or bones or the foot and ankle. It is extremely painful to touch and causes redness and swelling. I treat this condition with medications that are specifically for gout, which address the inflammation and decrease the uric acid. I will also recommend a diet low in uric acid to help reduce flare-ups. I will refer the patient back to their PCP for long- term management.
Acutely torn or ruptured tendons usually, but not all the time, require surgery to repair. Chronic tears can be treated with therapy or injections, but they also can need surgery. Like fractures, it depends on the severity and location of the tear or rupture as to whether I will have to take the patient into the OR. Partial tears can take 12 weeks to heal while surgically repaired tendons can take up to a year to heal. Recovery is long and slow, with bracing or splinting required to provide additional support as the tendon heals. Physical Therapy will play a major role in the healing process as well.
Make an appointment for Swollen Feet or Ankles
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