Duration Health

Leg, Ankle and Foot Pain

Introduction

Foot, knee and leg pain and injuries are common, especially those who are doing physically demanding activities such as hiking, backpacking, biking or climbing. Falling or twisting the leg can cause sprains to the ligaments and tendons that support the foot, ankle or knee – this will usually result in mild to moderate pain and swelling while you are still able to bear weight and walk. If after an injury, the joint feels loose or unstable, or if you are unable to bear weight, this indicates a more severe/higher grade sprain or possible broken bone (fracture) or even joint dislocation. Overuse injuries that cause dull, achy pain in the joint can occur in people who are carrying a heavy backpack or hiking for extended periods.

Treatment

For minor strains/sprains, follow the RICE treatment protocol:

  1. REST: if possible, try to take a day or two off strenuous activities to allow the injury to heal
  2. ICE: ice can decrease swelling and inflammation (you can apply ice for 20 minutes every 1-2 hours)
  3. COMPRESSION: wrapping the ankle or knee with an ace bandage will provide support to the joint and decrease swelling
  4. ELEVATION: keep the limb elevated above the heart to decrease swelling and inflammation
Consider taking ibuprofen or acetaminophen for pain relief.

For ankle and foot injuries, if you are unable to bear weight OR you have pain when you press on the outer or inner ankle bones OR you have pain when you press on the top of the foot, this may indicate a fracture, and you should seek medical care and get an X-ray. Bearing weight in this context means able to walk or limp 4 steps.

For knee injuries, if you are unable to bear weight OR if you cannot bend the knee more than 90 degrees, OR if you have pain when you press on the kneecap (patella) OR if you have pain when you press on the leg just below the knee, this may indicate a fracture, and you should seek medical care and get an X-ray. Bearing weight in this context means able to walk or limp 4 steps.

These rules aren't perfect, and a fracture could still be present even if you don't meet the criteria listed above.

If you are unable to bear weight or walk due to an ankle or knee injury, or if the joint feels unstable or is deformed, you should splint the joint. To apply a rudimentary knee immobilizer, keep the knee straight, wrap the knee in a support like a thick blanket or sleeping pad, then wrap with ace bandage or duct tape. For an ankle splint, find a strong support like a thick blanket or tent pole, and place the support around the ankle joint to stabilize it, and wrap with an ace bandage or duct tape.

When To Worry

Seek immediate medical care if you have any of the following:

Quick Guide

If you have

  • mild/moderate muscle aches

You may have

muscle strain

Consider using

ibuprofen (generic for Motrin®) 600 mg every 6 hours as needed for pain

OR

acetaminophen (generic for Tylenol®) 1000 mg every 6-8 hours as needed for pain (do not exceed 3000 mg per day)

OR

methyl salicylate-menthol (generic for IcyHot®) 1 application to affected area every 4-6 hours as needed

AND follow the RICE protocol above

If you have

  • mild/moderate ankle or knee pain
  • mild swelling
  • no tenderness over the ankle or knee joint or the other sites described above
  • you are able to walk

You may have

ankle or knee sprain

Consider using

ibuprofen 600 mg every 6 hours as needed for pain OR

acetaminophen 1000 mg every 6-8 hours as needed for pain (do not exceed 3000 mg per day)

AND follow the RICE protocol above

If you have

  • inability to bear weight or walk
  • tenderness over the ankle or knee joint at the sites described above

You may have

ankle or knee fracture (broken bone)

Consider using

ibuprofen 600 mg every 6 hours as needed for pain OR

acetaminophen 1000 mg every 6-8 hours as needed for pain (do not exceed 3000 mg per day)

AND splint the injured extremity AND seek medical care and get an X-ray

If you have

  • knee or ankle joint is grossly deformed after an injury
  • the foot or lower leg becomes purple/blue or very pale after an injury
  • you are unable to feel a pulse in the foot/ankle after an injury
  • you lose sensation to the foot/leg after an injury

You may have

severe fracture or dislocation or compartment syndrome or nerve or blood vessel injury

You should

seek emergency medical care

Reference

Cyclobenzaprine (generic for Flexeril) is a muscle relaxer. It is used to treat painful muscle spasm.

GeneralMedication

Methyl salicylate-menthol (generic for IcyHot) treats muscle aches.

GeneralMedication

Ibuprofen (generic for Motrin, generic for Advil) is a pain reliever and the most commonly used non-steroidal anti-inflammatory drug (NSAID). Ibuprofen is used to treat pain.

GeneralMedication

Acetaminophen (generic for Tylenol) is a pain reliever and fever reducer. Acetaminophen is used to treat pain.

GeneralMedication

Ibuprofen (generic for Motrin, generic for Advil) is a pain reliever and the most commonly used non-steroidal anti-inflammatory drug (NSAID). Ibuprofen is used to treat pain.

GeneralMedication

Acetaminophen (generic for Tylenol) is a pain reliever and fever reducer. Acetaminophen is used to treat pain.

GeneralMedication

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