Houston Methodist. Leading Medicine

Ankle News

Planning Health Care Services to Treat Foot and Ankle Pain

Ever see someone shuffling along without picking up their feet? Wonder what's wrong with that man or that woman in a wheelchair or on a scooter who looks perfectly able bodied? In fact, the body may be fine but it's the feet that are the problem. And without healthy, pain free feet and ankles, it's plenty hard to get around easily.

Health care professionals such as podiatrists, physical therapists, and orthopedic surgeons are very aware of just how common foot and ankle pain has become in the adult population. And it's not just the very old but also the middle-aged groups.

To find out just how prevalent (common) the problem of disabling foot and ankle pain has become researchers conducted a systematic review. They pooled together the data from eight comparable studies to get an estimate on prevalence, severity, and demographics associated with this condition. This is the first study of its type (an epidemiologic study) for this particular problem.

Epidemiologic studies provide a broad spectrum of information about conditions in order to direct or expand health care resources. The data gathered helps identify how many people are affected, where they are located geographically, and what these folks are like (age, gender, occupation, education level). The information is then used to target people at risk in hopes of preventing the problem or at least preventing disability from the pain.

The authors actually ran into a bit of trouble finding enough high-quality, comparable studies for this review. Just being able to define "foot and ankle pain" was a challenge. The ankle-foot complex has many parts (bones, joints, ligaments, tendons, muscles) and locations (top, bottom, inside edge, outside edge, toes, forefoot, hind foot, ball, heel, arch). It was difficult to find consistency in exactly which part of the involved foot and ankle was studied and reported.

Then the problem of categorizing pain was quickly obvious. If the pain isn't present on the exact day the study was conducted but the person has been having pain, does it count? How do researchers compare occasional pain with constant pain or mild versus severe pain? Location, frequency, intensity, duration, and timelines for pain are all important variables. This is why they only ended up with eight useable studies out of the initial potentially relevant 6,261 studies published on foot and ankle pain.

Even so, the authors were able to drill down through the material and come up with some interesting findings. First, there was an overall prevalence of foot/ankle/toe pain in 20 per cent of the adult population. That's one in five people.

In general, there was a greater prevalence of foot/ankle/toe pain in people aged 45 and older. And it turns out that foot pain is a bigger problem than ankle pain. The forefoot and toes seem to create the greatest pain and dysfunction. By age 50, over 50 per cent of the people polled reported disabling foot pain. Disabling pain refers to significant enough discomfort as to interfere with daily activities.

Women were more likely to report pain. That's not surprising since fashionable footwear often includes narrow shoes and high heels, which have a distinct affect on the feet. But there's more to it than just fashion footwear. As we get older, our feet tend to spread out and get wider. But shoe manufacturers have not altered shoes to accommodate for this change. And many people continue to wear the same size they have always worn putting up with the discomfort of a too-small or too-tight shoe rather than admit they need a larger size.

The conclusion offered from this systematic review is that foot (and ankle) pain is a bigger problem than we imagined. Some reasons for this could be identified (e.g., footwear, anatomical changes associated with aging). It is possible that there is a correlation between foot pain and other musculoskeletal problems (e.g., knee, hip, or low back pain).

There is a need for further study in the future to get some agreement on what's going on with foot and ankle pain in middle-to-older age groups and why it's happening. Then we can address the need for more health care services directed at the feet and identify what those services should be to best serve our seniors (or should we say our "middlers" and our seniors?).


Martin J. Thomas, et al. The Population Prevalence of Foot and Ankle Pain in Middle and Old Age: A Systematic Review. In PAIN. December 2011. Vol. 152. No. 12. Pp. 2870-2880.

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