Foot and Ankle Pain: Diagnosis and Treatment

In my clinical experience, the most commonly seen foot condition--and also a reason for referral to see a specialist--is plantar fasciitis. Other conditions that the primary care clinician will see include trauma, ankle sprains, and fractures. Less commonly seen conditions of the foot and ankle include Morton’s neuroma, tibialis posterior tendonitis and there’s a vast subset of conditions associated with patients with diabetes as well as peripheral vascular disease.

Since we are dealing with arthropathies and also inflammatory conditions of the soft tissues, treatment often begins with the nonsteroidal anti-inflammatories as well as the oral steroids, and sometimes the primary care physician will even give a steroid injection. When we’re talking about trauma and postop, treatment may involve narcotic analgesics and also physical therapy and other pain management modalities.

Surgical intervention is not usually the first treatment option. In most cases, we try to initiate some sort of conservative treatment plan. Of course, in cases of trauma such as fractures that are dislocated or unstable, then surgical intervention would be indicated initially. And other conditions, such as infections or tumors would also warrant a more aggressive approach.

In summary, many of these conditions can be managed conservatively by the primary care provider, and in those cases where initial conservative management with anti-inflammatories given orally, injected, topically or even narcotics or other types of pain medications do not resolve the issues, then they should be sent to a specialist for further workup.