severe foot pain

by Russ W
(Ft. Myers, florida)

I am 56 years old and in great physical shape. I work out and have a 33 inch waste. From years of running, basketball and tournament tennis, the foot doctor says I have no cartlidge left where my foot meets the bottom of my leg. So when I move my foot up and down, I am bone on bone.

I also have severe arthritis. In the mornings I can barely walk and have to hobble, or (literally) walk on the balls of my feet. When walking in the day, I have to invert my feet to try to create separation in the joint to avoid the pain of walking... It's painful 24/7 and I am not whimpy about pain.

I walk like I am 80 years old..... Any suggestions or new ways to fix this?

RESPONSE

Hi Russ,
I often tell my patients that feet are like tires on a car; the more you use them, the quicker they will wear out. Unfortunately, that is what is happening in your case.
When you say you are having pain where the lower leg meets the foot I assume you are talking about the ankle joint. The fact that you have "no cartilage" where the foot meets the leg, eg: ankle joint, means your ankle is working by bone rubbing on bone instead of cartilage moving against cartilage. For most people this would cause pain and of course the more active you are, the more pain you can expect.
The solution for ankle pain is not simple as ankle implants (joint replacements) have not yet reached the point where there is a high degree of success, so in most cases it is not a real option.
One thing I look at in individuals with ankle pain is the relationship of the way the foot moves within the ankle joint. If the foot excessively flattens out during gait, this will created an abnormal alignment between the foot and ankle. Not only will it cause premature wear on the ankle joint itself, BUT, sometimes things can be done to better align the foot relative to the ankle and this will actually reduce some of the ankle pain.
We do this with the use of an orthotic which fits in your shoes. The orthotic prevents the foot from excessively flattening out and in doing so creates a better alignment between foot and ankle and usually results in less pain and more movement within the ankle joint.
Your podiatrist should be able to determine if this is your situation.
Other options available are mainly short term in nature. This would include immobilization of the ankle in an effort to allow the joint to quiet down. Additionally, you could also consider physical therapy whose aim would be to reduce inflammation and thus pain.
Oral medication as well as cortisone injections may also be helpful. The problem here is that most of these options are not long term solutions.
My suggestion is to have your foot to ankle alignment evaluated, see if an orthotic might help and try that with some physical therapy and perhaps oral anti-inflammatory medication.

Marc Mitnick DPM
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