Mechanical foot and ankle pain can be a confusing experience for the estimated 15% of adults in the United States. It is a separate, sometimes overshadowed experience from systemic arthritic changes in the foot. When the foot pain stems from an isolated area in a specific tissue of the foot or ankle, the cause is generally mechanical. Mechanical in this context simply indicates that the pain is coming from a part of the body in motion, and is often intensified during weight-bearing activities. The key to understanding the specific tissue involved in the pain is knowing the nature of the pain’s location and a specific event that may have triggered the pain. Once this is understood, treatments including bracing, taping, or shoe inserts designed for the specific tissue can be implemented to reduce stress on that area and promote natural healing.
Braces for Foot and Ankle Pain
There are many benefits to wearing a brace. They can range from immobilizing a joint in order to relieve pain to simply providing a little extra support for a mildly unstable joint. A brace can be used to control a flat foot, but the best results are achieved when the brace is used in children while the foot is still flexible. Providing arch support and controlling abnormal motion in the rearfoot and midfoot, rigid and semi-rigid orthotics have been successful in treating many foot problems. Braces are frequently used to control foot drop and to support the ankle in patients with neurological disorders. In addition, braces can help to prevent injuries and also provide support and protection when recovering from a foot or ankle injury.
Braces are external supports that are worn to limit the movement of a particular joint. Patients may find them to be beneficial if they have instability in the foot and ankle, or if they are simply looking for extra support. Braces are also used to immobilize a joint in the case of an acute or chronic injury in order to relieve pain. There are two types of braces: removable and non-removable. The non-removable type is made of fiberglass or a similar material and is molded to the patient’s leg and foot. This type of brace cannot be removed by the patient and is usually only taken off by the physician. Removable braces are usually made of an elastic material, which is fastened to the foot and leg with Velcro straps. These are more popular than the non-removable type of brace because they can be taken off at night and are also easier and more comfortable to walk in.
Types of Braces
A brace has a hard or soft structure that can fit inside a shoe and around the ankle. They may contain a custom insole and have straps or laces to secure them to the foot and leg. Braces can be designed to restrict the motion of a joint as in the case of an ankle ligament injury or provide support and improved cushioning of the sole of the foot in the case of severe arthritis. There are also braces that are designed to alter the biomechanics of foot and leg by realigning the foot to a more normal position. This is typical in patients with flatfoot deformities or posterior tibial tendon dysfunction. These latter types of braces are the most complex and expensive, and it is difficult to predict who will benefit from them.
Braces are external supportive devices designed to improve the stability of the motion of joints affected by injury, a degenerative condition, or postoperative repair. They prevent the increase of pain and swelling, and the progression of joint disease or deformities. It is thought that joint mechanics are altered by braces and they can lead to beneficial changes in the alignment of the leg, knee, and ankle. They may also prevent the development of abnormal gaits that patients sometimes have as a result of avoiding pain. This is important in some patient populations such as those with rheumatoid arthritis. There is a general lack of scientific evidence about how braces work, which patients benefit from them and under what conditions they benefit. This is in part because there are many types of braces and a typical treatment is in some patients the use of several different types of braces in a trial and error fashion. This is likely due to the high degree of variability of foot and ankle pathology.
Benefits of Braces
At last, the use of a brace or support is relatively low cost compared to various treatments for foot and ankle pain. Each patient has to decide what their foot and ankle conditions are and if a brace will be beneficial towards the recovery of their pain.
In a recent systematic review, it was found that there is significant benefit from the use of braces and supports in treating both acute and chronic pain conditions of the foot and ankle. A similar recent meta-analysis found that the preventative use of ankle supports, assessed that in most cases it related with the use of various ankle braces, significantly reduced the occurrence of ankle sprains in patients with a history of ankle injuries.
In many cases, a lace-up or strap brace can provide the compression and support for minor injuries such as inversion sprains and general foot and ankle pain. Also, new braces that combine compression with silicone padding have shown to be effective on painful conditions such as plantar fasciitis.
The use of an ankle foot orthosis (AFO) made of rigid material has shown to be effective in preventing the foot from dropping, giving the added stability to prevent tripping and falling in patients with neurological conditions. The use of a Stirrup Splint has been found to be more effective than taping for patients with chronic ankle instability, especially when they are active in various sports. It provides the same support as taping, but allows more freedom in range of motion without losing support.
When there is mild to moderate pain in the ankle and foot, a brace may be the right choice. It helps support the region affected and stabilizes the area to allow the pain to subside. The added stability can help prevent further damage to the ankle and foot. Many different types of braces have been designed for various activities and conditions.
How to Choose the Right Brace
Consider the type of footwear that you wear and the brace height that will be suitable. Do you intend to wear the brace with sandals, shoes, and boots, or a combination of all? Many braces are specifically designed for shoe type and activity, and there are even a variety of ankle braces designed for high heels. If you wear tall boots or have a brace and prosthesis, then a shorter height may be better, or a higher brace that can be folded over the top to cushion your shin. Always ensure a good fit inside your footwear and avoid anything too bulky that causes pressure.
Do you have an active lifestyle? If you intend to still walk long distances or participate in activities, then a brace that is lightweight and supportive is essential. Unfortunately, many braces are bulky and constructed from materials that are not suited to activity. However, there are many athletic and lightweight braces available. If in doubt, contact the manufacturer to ask, and they should be able to advise.
Consider what condition you are dealing with. Not all braces are created equal, and many are designed to target specific areas of the foot or ankle. Find a brace that is suited to the area you need support, as well as one that provides a good fit. A well-fitting brace will be more comfortable and provide better support. Sizes can vary, so take careful measurements of your foot or ankle to ensure the best fit.
Choosing the right brace is important for getting the best results and involves considering the type of brace and the specific benefits that they offer.
Splints for Foot and Ankle Pain
There are a few benefits of splinting. They are easy to use. The only real work involved in using a splint is putting it on and taking it off. Unlike braces, you don’t have to remove your shoes and socks in order to put on a splint. It is also easy to tell if the splint is working. If you are waking up in the morning and you feel better than you did the previous day, that is a good sign that the splint is working. Often splints can be more effective in pain reduction than using an in-shoe orthotic. This is largely due to the fact that when the foot is held in a more static position, the soft tissue structures have a better chance at healing. This is also beneficial for those that have severe flat feet and orthotics are not providing enough control of the foot.
A splint is a device that wraps around the back of your heel and underneath your foot. It also has a support piece on the top of your foot to hold the foot in a more neutral position. There are many different types of splints that do different things. Posterior night splints keep the ankle at 90 degrees while the foot splints are designed to keep the foot in a neutral position. Boot walkers have a hard plastic shell around the foot and ankle to keep it from moving. Air stirrup splints are similar to the splints that you get to stabilize a knee, except air stirrups are designed for the foot and ankle.
Types of Splints
Ankle foot orthoses resemble a working boot and can vary in the amount of immobilization and degree of customizability. They are effective for conditions requiring intermediate to long term support. A recent innovation is the choice of wearing a pneumatic brace. This is a removable boot which can be inflated to attain varying levels of compression and support. This is effective for acute injuries such as ankle sprains and can be used at different stages of the healing process.
Dynamic splints allow controlled motion of the foot and ankle. These are useful for conditions that immobilization would exacerbate, but a period of relative rest would benefit, usually associated with a bad wound site. A Scottish Rite brace can be used for gradual correction of flexible deformity in the pediatric patient. This may avoid the need for surgical intervention.
Static splints maintain a constant position of the foot and ankle. A short leg posterior splint is good for immobilizing the ankle and hindfoot. A forefoot Add a Spoon is effective for maintaining the foot in a neutral position.
Several types of splints exist to treat foot and ankle pain. They all share the common goal of stabilizing the foot and ankle and immobilizing painful structures. They are easy to apply and are usually adjustable, allowing the clinician to control the amount of stretch or load. The amount of immobilization necessary will depend on the diagnosis and acute versus chronic nature of the condition, considering the patient’s needs and comfort as well as the clinician’s goals and the nature of the patient’s condition.
Benefits of Splints
In terms of pain within the foot, ankle foot orthoses have been found to be effective in reducing pain at the medial aspect of the knee and are also beneficial for patients with rheumatoid arthritis. Functional ankle instability (which occurs in approximately 20% of people who experience an ankle sprain) has been found to cause recurrent sprains and a feeling that the ankle is ‘giving way’. A study involving patients with chronic ankle instability found that people who wore a semi-rigid orthosis had significantly less pain and reduced episodes of the ankle giving way. This demonstrates the positive effects that these devices have on muscle activity and joint stability.
Thirdly, for mild to severe drop foot, short length styles that only extend to the ankle are available. They will provide the support needed to increase the ability to clear the foot during swing phase and prevent the foot from slapping the ground. Some AFOs have extra support on the side of the ankle to counteract foot drop and help with stability. Articulated AFOs have hinges at the ankle which allow for easier walking and can be used for more complex ankle/foot instabilities. They are available in several different styles and lengths depending on the amount of control and support needed. One of the biggest advantages of AFOs is that they are easily adjusted by the clinician to provide the best possible fit and support. This is essential because correct fit can mean the difference between an AFO being helpful or harmful. Unfortunately, if AFOs are not fitted properly or if the user has changed weight or shoe size, they may not be supportive and could potentially cause further harm.
How to Choose the Right Splint
Often times a specific condition may have a number of different splints designed to treat it. For more severe conditions, especially those requiring immobility of the foot and/or ankle, a healthcare provider may recommend a custom-molded plastic splint. Although custom splints are generally more expensive, they are usually more comfortable and may facilitate easier resumption of daily activities. If a custom splint is not recommended, there are several different types of prefabricated splints designed for immobilization of specific parts of the foot and ankle. When looking for a prefabricated splint, it is important to find one that comfortably and effectively immobilizes the affected area. Features to consider with prefabricated splints include the amount of adjustability (they may need to be adjusted if there is swelling in the foot or ankle), the ease of use, and the durability of the splint. Prices of prefabricated splints can vary, so if cost is a significant factor it may be worthwhile to look at several different brands to find one that is more affordable but still effective.
– The specific part of the foot or ankle that needs to be immobilized. – The comfort and fit of the splint. – The ease of use of the splint. – The cost and durability of the splint.
Once you and your healthcare provider have decided that a splint is appropriate for your condition, your provider will recommend a specific type of splint based on the underlying condition and its severity. Some features to consider when choosing a splint include:
Orthotics for Foot and Ankle Pain
Orthotics are a common treatment recommended for various foot and ankle problems. An orthotic is a supportive device that is worn inside the shoe. It can provide relief and correction for a lot of foot and ankle problems. They come in all different shapes and sizes, and no one orthotic is ideal for everyone. There are also custom-made orthotics which are made specifically for your feet. OTC (over the counter) orthotics are made for the general public. If you choose to go with an OTC orthotic, it is best to go with one that is somewhat firm because the cushiony-soft orthotics provide little to no support or correction. As for shapes and sizes, the best product is the one that feels most comfortable and supportive. This is often determined by trial and error, but a foot care specialist might be able to guide you in the right direction. Deciding between custom-made orthotics and OTC depends on the amount of correction and support your foot condition requires and the pain experienced. A foot care specialist or doctor can give a very good idea of the severity of the foot condition and future problems that may arise if the condition goes uncorrected. This can be used as a guide in making an informed decision on the best orthotic suited for you. An OTC orthotic provides a general solution to minor foot problems and pain. Custom-made orthotics are designed to provide a solution to specific foot conditions in need of serious correction and support. Custom-made orthotics are often the best choice for more serious foot problems and pain, although they are quite expensive. This is often a hindrance, but a good often ignored point is that custom-made orthotics can sometimes prevent the need for surgery in the future, which might cost more than the orthotics themselves and then some.
Types of Orthotics
Orthotics can be divided into several types, based on which part of the foot they are meant to control.
- Simple insoles. This type of orthotic is designed to control the function of the foot. They may be made from a variety of materials with the patient’s needs and activity level taken into account.
- Insoles with medial arch support. This type of orthotic is designed to support the foot when it is tired and aching, and to prevent the progression of flat feet. If the patient has a flexible foot, this type of orthotic may be tried to control the foot and prevent it from splaying onto its inside border.
- Functional (rigid) orthotics. This type of orthotic is used to control the motion of two frequently occurring joints in the rearfoot and midfoot, which are capable of causing a wide variety of problems (the joints are the subtalar joint and the talo-navicular joint). If these orthotics are to be successful, it is crucial that the correct joints are controlled in the correct planes of motion. Full biomechanical gait analysis may be necessary to determine this. These orthotics can be constructed from a variety of materials. The use of plastic is common, and some are made from a pliable graphite which is said to be more comfortable. The harder the material of the orthotic, the more aggressive control it will have over the foot.
Benefits of Orthotics
The success rate has been found to be higher in studies testing a particular “best” orthotic against a “best” other form of treatment, rather than comparing a variety of different orthotics to other forms of treatment. However, this has been offset against findings that the more costly double-blind randomized tests have not shown a significant difference in efficacy between orthotics and simpler treatment or between custom-made and prefabricated orthotics for certain conditions. In general, there is evidence to support the use of orthotics as a treatment for painful conditions of the foot and lower limb. A consumer survey on orthotics found that most people who bought orthotics did so to alleviate pain, improve balance, or correct a foot deformity. Results from this survey showed that 76% of users reported meeting or exceeding their expectations, with only 7% reporting a worsening of their condition.
How effective are orthotics at the moment? This question has been the root of much debate as qualitatively, a wide range of orthotic products and methods of production has made it difficult to generalize results. An orthotic can be anything from felt pads to custom-made shoe inserts, and there is an enormous range in between these two ends. These differences in various studies on the effectiveness of orthotics can result in wide-ranging results. It is generally accepted that the more complex the foot disorder, the more likely it is that an orthotic will be of benefit. For some pathologies, simple shock-absorbing insoles may be adequate, while for others, a custom-made shoe insert and possibly footwear will be required.
Orthotics have been described as a means of “helper’s or assistant’s work,” and the benefits they offer are varied. By realigning the structure of the foot, orthotics correct imbalances and improve the overall function of the foot and lower leg. This can prevent a number of painful conditions from occurring or stop their progression. Without the pain or the progression of deformities, muscles can be prevented from weakening and wearing out. This could be the factor that prevents further progression of conditions such as arthritis or tendonitis. By providing cushioning and support for the foot arch, abnormal or excessively high loading on a particular area of the foot can be prevented. This can prevent conditions such as stress fractures and the pain associated with osteoarthritis in later life. By enhancing the shock absorption of the feet, orthotics can also prevent pain and stress fractures in the lower legs. In certain cases, the help provided by orthotics can reduce the need for surgery and the cost and inconvenience that entails.
How to Choose the Right Orthotic
With so many choices in the orthotics market, it can be difficult to determine what the proper solution is for you. It is important to understand that each orthotic is designed for a specific function or problem. The biggest mistake most people make is simply purchasing an orthotic over the counter without knowledge of what type of foot problem they have. It is important to know what specific type of foot condition you are dealing with. Make sure to get a diagnosis from a foot specialist who can then lead you in the right direction. Where many health care professionals are trained in the past to prescribe rigid orthotics for all foot conditions, newer studies have shown that this is not the proper strategy for several different types of foot problems. A gout sufferer, for example, would require an orthotic with maximum cushioning support, whereas a person with a flat foot may require a functional foot orthotic with an arch support. A person with a flat foot may require an orthotic with arch support. A functional foot orthotic is semi-rigid with a heel cup and arch support. These types of orthotics are used for many different foot conditions and are a good generalized solution for those who don’t have very specific requirements. After determining what type of orthotic you will need, it may be necessary to try different products before making a final decision. An orthotic is a long-term investment towards the health of your feet. With the right one, you can potentially save thousands of dollars in medical bills and prevent surgery later on in life.
