Immobilization with removable walking brace for treatment of chronic foot and ankle pain

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 pai n (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 weig ht-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 repea t 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 a nd ankles) immobilized the ankle in neutral position and included a rigid r ocker 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 improve d 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 nu mber of abnormal physical findings decreased from initial (6 +/- 3 abnormal physical findings) to follow-up evaluation (3 +/- 3 abnormal physical find ings) (P < 0.001). The average number of diagnoses per foot and ankle decre ased from initial (4 +/- 1 diagnoses per foot and ankle) to follow-up evalu ation (2 +/- 1 diagnoses per foot and ankle) (P < 0.0001). Improvement of p ain was independent of duration of pre-existing symptoms, patient age, gend er, or type of brace used. In summary, immobilization with a removable walk ing brace may improve chronic foot and ankle pain and localize the primary source of symptoms.