Alternating foot and ankle pain

by Jeff
(U.S.A.)

For about 8-10 months now, I have had alternating pain, starting with what starts like the arch of my right foot soreness, then it progresses through to the top of my foot, feeling like somebody is driving a tent spike through it.

It will get progressively worse until so severe I cannot put any weight on that foot, lasting anywhere up to 4 days.
Then, slowly the pain will decrease until it's just a soreness like a strain.

All of this can last up to two months.

Then, when this has subsided, my left ankle will start to ache within a couple days, mildly at first, then get worse to where I limp again because it is difficult and painful to bend my ankle when I step.
Along with this, I have very limited motion as far as bending the ankle up or down.
Again, this will slowly subside, until the pain is just a bit of soreness, and just about that time (again anywhere from 6 weeks to 2 months) my right foot will start to ache again.

I have tried new shoes thinking my old tennis might be worn out, tried wearing my work boots, tried sleeping in the recliner, couch, and even a different bed, thinking I may just be sleeping funny or perhaps crossing my ankles while sleeping.

None of this has made a difference, so I am very puzzled.

I have not started any new activities or exercise routine, and in the months that this has been happening, as soon as I noticed the alternating pattern, (right now I am in the third episode with the right foot) am very conscious about how I walk, or anything different that I do.

RESPONSE

Hi Jeff,

This is a problem that requires and examination and some tests performed by a doctor. I say this because your symptoms are atypical of what most people present with. Most musculo-skeletal pain, even severe in nature, once healed will tend to stay healed. The only time the same type of injury will re-occur is if there is some activity or action that is setting it off.

An example might be wearing a certain pair of boots to do a physical task. You do not normally wear these boots, but every now and then are required to wear them to do some physical work. These particular boots are causing some sort of issue with the way they fit you (too loose, too tight, not enough support, too rigid, too flexible, etc.) and so when you wear them they set off a problem with your foot and ankle.

In your narrative you pretty much have attempted to look for a scenario that may be causing your pain and you have come up with nothing.

Having said that, the first thing that came to my mind after reading your story is the possibility of gout.

Gout is an increase in uric acid in the blood which then has a tendency to insert itself into a joint, particularly the joints of the feet (and hand to a lesser extent). The uric acid crystals in the joint then inflame the joint and can cause severe pain. Stabbing with a tent stake would be a good example.

Typically, this pain will come on out of nowhere and will usually occur first thing in the morning with the patient wondering why their foot hurts so much as all they have been doing is sleeping.

The pain will get progressively worse over the next few hours, usually bad enough to force the patient to limp. In most cases the affected area will become red, hot and swollen. You do not mention any of those symptoms.

The pain will be very severe for a few days, but ultimately will begin to taper off until you reach the point where there is either no pain or a slight remnant of pain.

Because your blood levels of uric acid remain high you can then have another attack at almost any time. The second attack can be in a different area or it can occur in the same area and again you will go through the same set of symptoms, only for the pain to eventually subside.

So, as you can see, it kind of sounds like your symptoms are consistent with gout. It should be noted that there are other metabolic diseases that can cause the type of pain you describe but in order to determine what is going on you will need to see a doctor, have an examination and some blood work as well.

Marc Mitnick DPM
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