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 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.