Patient Education: Non Surgical Treatment Options

Non-Surgical Foot Treatment

These treatment options relate to the three conditions mentioned in the causes of foot pain section: Bunions, Hammer Toe, and flat feet. Please ask your physician before starting any treatment.


Bunions

Bunions are best treated as early as possible. Proper footwear, shoe inserts, night splints, and anti-inflammatory medication can all help reduce symptoms and may partially reverse the process.

To get some great rules for choosing the right shoes check out the American Orthopaedic Foot & Ankle Society page: 10 Points of Proper Shoe Fit.

 


Hammer Toe

Hammer Toe can also be helped by choosing the right footwear. In addition:

Padding:
Padding can be arranged on the foot to redistribute pressure on the affected area while wearing shoes.
Trimming:
This should never be attempted except by a healthcare professional.
Splints:
Specially designed splinting may provide some relief and partially reverse the process if used early enough.

 


Flat feet

The treatment options for flat feet depend on the type. There are 2 types of flat foot: Rigid and Flexible. To tell the difference simply raise the foot off of the ground. A flexible flat foot will naturally regain the arch when the foot is lifted but a rigid flat foot will remain flat.

 

Flexible Flat Feet
It is estimated that about 20% of people have flexible flat feet. Most of them never develop any problems. Therapeutic shoe inserts or arch supports may help to relieve discomfort.
Rigid Flat feet
A rigid flat foot can be the result of more serious misalignment or malformation of the bones of the foot. Options for treatment depend on the cause of the condition. They may include casting or splinting the foot. Surgery may be necessary for long term results.

 

 

Non-Surgical Ankle Treatment

The treatment options covered here relate to osteoarthritis, although many of them may be helpful for patients with other arthritic conditions. Please ask your physician before starting any treatment.


 

Exercise

Moderate doctor-prescribed exercise is an integral part of treating arthritis. Joints that are not regularly exercised can become tight and painful. Activities such as walking, swimming or gardening can assist in keeping your bones strong and your joints limber, which may help relieve stiffness. Low-impact exercise will not wear out your joints. Although exercise may sometimes cause discomfort, proper exercise will help nourish the cartilage, strengthen the muscles, and prolong the life of your joints.

Aquatic Therapy

Aquatic therapy is an excellent form of exercise to help manage arthritis pain. Water’s buoyancy helps protect your joints from impact injury. Water also resists movement, which is helpful for strengthening. Hydrostatic pressure (the pressure exerted by the water pushing on your body) can also assist with reducing the swelling in joints and edema in the legs.

Walking

Walking is an excellent form of endurance exercise for almost anyone, including those with arthritis. Be sure to have a good pair of walking shoes to help cushion impact. Check with your physician to obtain any exercise precautions or guidelines. You should be able to speak clearly without feeling out of breath when you are walking. Always warm up and cool down by walking slowly.

How much exercise is too much?

If you note increased joint swelling, decreased joint motion, unusual or persistent fatigue or continuous pain, you may be exercising too much. You should expect some muscle soreness, especially if you are just beginning an exercise program or have changed exercises. Joint pain should not last more than several hours after exercise.

For an in-depth guide on starting and maintaining a walking program, reference Walk With Ease by the Arthritis Foundation.

How do I stay consistent with exercise?

  • Seek help from a health care professional to assist you in setting up an individualized program.
  • Make a plan! Write it down! Set goals!
  • Exercise at the same time each day so it becomes part of your routine.
  • Find an exercise buddy.
  • Look for an appropriate exercise class.
  • Stay in the habit of doing some exercise each day.
  • Vary your exercise routine and rotate your exercises.
  • Evaluate your progress and celebrate your success.

 

Physical Therapy

A physical therapist may demonstrate a variety of low-impact exercises designed to increase the strength and mobility of your ankle joint. However, you should only perform the exercises that are ordered by your surgeon.


 

Modify Your Activities

Proper body mechanics can lead to less strain on your joints. The following activity modification guidelines may be helpful:

  • Practice good posture by standing up straight.
  • Avoid stooping while standing.
  • Avoid sitting in low chairs to reduce stress on your knees when sitting and standing.
  • Avoid impact-loading activities (e.g., running, jumping, etc.).
  • Reduce climbing activities (e.g., stairs, hills, etc.).
  • Avoid any activity that causes prolonged discomfort.

 

Weight Control

Being overweight puts weight-bearing joints under extra pressure and stress. Because the joints are eccentric (not in the centerline of your body), the force across the joint is three times greater than a person’s body weight when that person balances on one leg. For example, a 150-pound person places up to 450 pounds of pressure on the joint. The good news is for every single pound lost; subtract three pounds of force off the ankle. The bad news is for every one pound gained; add three pounds of force to the ankle. Extra pressure on your joints can make arthritic symptoms worse, leading to pain and stiffness.

A well-balanced diet coupled with regular doctor prescribed low-impact exercise can help reduce excess body weight, decrease pressure on the joints and increase joint strength. Many claims have been made concerning diet as a cause of arthritis but none have been proven to date. If you have been diagnosed with gouty arthritis, some dietary restrictions are indicated. Maintaining your ideal body weight will help keep your joints healthy. If you are overweight, ask your doctor to refer you to a Registered Dietician to help you create a healthy and effective weight loss plan.


 

Self-Help/Assistive Devices

Simple everyday tasks may be hard to accomplish with arthritis. Utilizing self-help/assistive devices can make life much easier. Ask your physician or physical therapist about the following self-help devices.

Assistive Devices

If you are walking with a limp, consider an assistive device such as a cane, a crutch or a walker. Ask your physician or occupational therapist about different types of assistive devices and which type is best for you.

Canes

It is important to use canes properly since you can actually stress other joints with an abnormal gait (walking) pattern. Canes should be used in the opposite hand of the affected joint; for example, hold a cane in your right hand if your problem is with your left leg.

Walkers or Crutches

If you are unsteady with a cane or cannot grip it properly; you may be able to use either one or two crutches or a walker. This will provide support and balance.

Self-Help Tools

The self-help devices listed below can help minimize pain, discomfort, stress, and can assist you in accomplishing tasks. Ask your physician or physical therapist about these self-help devices:

  • Orthotics to improve foot alignment
  • Braces for knee support
  • Abdominal supports to reduce stress on the back
  • Long-handled reachers or grabbers to help you pick things up without bending
  • Sock sliders to help you put on socks

 

 Heat and Cold Treatments

Heat or cold treatments may be used to decrease pain and increase flexibility. Heat or cold treatments may be combined with the exercises prescribed by your physical therapist.

Heat Cold
  • Use prior to activity
  • Increases blood flow
  • Improves motion
  • Decreases joint ache
  • Helps relax muscles
  • Use after exercise
  • Decreases blood flow
  • Decreases swelling
  • Better for pain
  • Reduces inflammation

You may want to purchase a gel pack that can be kept cold in your freezer or heated in a microwave.


 

Nutritional Supplements

Recently, nutritional supplements have become popular with arthritis patients. Glucosamine and Chondroitin have been the most widely used. Consult your physician before beginning treatment.

Glucosamine

Glucosamine is a building block of cartilage and may be found as a hydrochloride or sulfate. It may be useful in strengthening and repairing cartilage. Studies have shown it to be effective in reducing pain, especially painful arthritis of the hands. Glucosamine is not a cure and has not been shown to rebuild cartilage.

Chondroitin Sulfate

Chondroitin Sulfate is commonly taken in conjunction with Glucosamine. It is found in cartilage and acts somewhat like a sponge for the fluid found in cartilage, which makes the cartilage more elastic and spongy. Chondroitin may help prevent the breakdown of cartilage.

Vitamins C and D

Some studies have indicated that patients who do not meet their daily Vitamin C and D intake requirements may have a higher incidence of arthritis. Arthritis patients should take vitamins regularly, or as prescribed by a medical professional.

Calcium

Some people confuse osteoporosis with osteoarthritis. Osteoporosis is a thinning of the bone, not the joint. This thinning can be slowed by maintaining proper calcium intake and including weight bearing exercise as a part in your workout regimen. Osteoarthritis is the wearing down of the cartilage between bones in a joint. In response to increased pressure on the joint calcium may accumulate in bone spurs around arthritic joints.

Talk to your physician before taking any medications.


 

Over-The-Counter Medications

Many medications are available to help treat arthritis and can function as a pain-reliever and as an anti-inflammatory to help relieve joint swelling and pain. These medications can lead to improvement in everyday function and quality of life. Always consult your physician before beginning treatment.

Tylenol®

The non-narcotic analgesic Tylenol® is generally effective in relieving minor pain and discomfort. The Academy of Rheumatology has suggested this as the first-line arthritis treatment. Tylenol®, however, does not reduce the inflammation caused by arthritis. Ask your physician about dosing and safety.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Nonsteroidal anti-inflammatory drugs (NSAIDs) can be purchased over-the-counter with some common forms being Aspirin, Motrin®, Advil®, and Aleve®. NSAIDs are usually indicated for mild to moderate arthritis pain and may be effective where Tylenol® is not. They are very effective in reducing inflammation caused by arthritis. However, they can also increase your chance for gastric (stomach) ulcers and can alter your blood by affecting your platelets. Therefore, patients with stomach problems, bleeding problems or on blood thinners should not take these medications. Always check with your physician before starting NSAIDs.

Patients with chronic pain may need to take medication daily. However, many may only need to take it when necessary or when they anticipate a strenuous activity that is likely to lead to pain. This may not be true for patients with inflammatory forms of arthritis such as rheumatoid arthritis or lupus.

Topical Creams

Many topical creams on the market can reduce pain from arthritis. The American College of Rheumatology does recommend Capsaicin as part of a treatment plan. Capsaicin is thought to help block the release of the body’s painkillers while also blocking a chemical that transmits pain signals. Check with your physician before applying any topical creams.

Talk to your physician before taking any medications.


 

Injections

Cortisone

Cortisone, which is injected directly into joints, may be used to help relieve both swelling and pain. Cortisone is a naturally occurring hormone produced by the adrenal gland. It helps regulate inflammation and when injected into a joint it can relieve or reduce both swelling and pain. Relief usually occurs within a day or two of the injection. Patients do not need to change activities following injections. Many patients elect to receive cortisone injections prior to big events when they will be more active.

Cortisone may play a role in weakening tendons or cartilage if used too often. Therefore, most physicians limit its use to a few times per year depending on the circumstances.

Always consult your physician before participating in any treatment option.


 

All patient education materials are provided by OrthoPatientEd.com and have been reviewed by our Advisory Board of leading Orthopedic Surgeons to ensure accuracy. All materials are provided for informational purposes only and are not intended to be a substitute for medical advice from your orthopedic surgeon. Any medical decisions should be made after consulting a qualified physician.
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