title: Immobilization with removable walking brace for treatment of chronic foot and ankle pain.
abstract: Fifty feet and ankles in 47 patients (three bilateral) (26 women and 21 men; average age, 44+/-15 years) were treated for chronic foot and ankle pain (duration: minimum, three months; average, 27+/-35 months; range, three to 132 months). Evaluation included detailed history, physical examination, and radiography. Initial treatment consisted of immobilization (full weight-bearing) using a removable walking brace (23.5 hours per day, including in bed at night), with standing and walking limited to activities of daily living. Follow-up evaluation included assessment of pain response and repeat physical examination. There was a history of trauma in 32 (64%) feet and ankles. Braces (pneumatic in 31 [62%] and double-upright in 19 [38%] feet and ankles) immobilized the ankle in neutral position and included a rigid rocker sole. After an average of 13+/-10 weeks (range, three to 50 weeks) of brace use, pain symptoms were improved in 35 (70%), unchanged in 11 (22%), and worse in four (8%) feet and ankles. Physical examination was improved in 43 (86%) feet and ankles, unchanged in six (12%) feet and ankles, and worse in one (2%) foot and ankle. In all 50 feet and ankles, the average number of abnormal physical findings decreased from initial (6+/-3 abnormal physical findings) to follow-up evaluation (3+/-3 abnormal physical findings) (P < 0.001). The average number of diagnoses per foot and ankle decreased from initial (4+/-1 diagnoses per foot and ankle) to follow-up evaluation (2+/-1 diagnoses per foot and ankle) (P < 0.0001). Improvement of pain was independent of duration of pre-existing symptoms, patient age, gender, or type of brace used. In summary, immobilization with a removable walking brace may improve chronic foot and ankle pain and localize the primary source of symptoms.
authors.affiliation: New England Baptist Hospital, Boston, Massachusetts, USA.
authors.forename: M G
authors.initials: MG
authors.lastname: Crincoli
authors.forename: E
authors.initials: E
authors.lastname: Trepman
mesh_terms: D000328:Adult; D000842:Ankle / Q000503:physiopathology*; D001915:Braces; D002908:Chronic Disease; D005260:Female; D005528:Foot / Q000503:physiopathology*; D006801:Humans; D007103:Immobilization; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D059408:Pain Management; D016896:Treatment Outcome; D016138:Walking