Management of Bilateral Foot Pain with Arch Support Request
Provide arch supports (heel cushions and arch supports) as initial conservative treatment, combined with NSAIDs, activity modification, avoidance of barefoot walking and flat shoes, and consider weight loss if indicated. 1
Initial Conservative Management
The American College of Foot and Ankle Surgeons recommends a comprehensive conservative approach for bilateral foot pain that includes: 1
- Arch supports and heel cushions should be provided as first-line mechanical support 1
- NSAIDs for pain and inflammation control 1
- Activity limitation to reduce mechanical stress on the feet 1
- Footwear modifications: avoid flat shoes and barefoot walking 1
- Weight loss if the patient is overweight or obese, as this contributes to pain and disability 1
Orthotic Considerations
Since the patient previously had arch supports before incarceration, this suggests prior benefit from orthotic intervention. The EULAR guidelines support providing orthotics when pain during activities of daily living impedes functioning: 1
- Over-the-counter arch supports can be initiated immediately for patients with foot pain 1
- Customized orthotic devices may be considered if symptoms persist after 6 weeks of conservative treatment 1
- If the patient requires specialized fitting or custom orthotics, referral to an occupational therapist or orthopaedic shoemaker may be appropriate 1
Additional Conservative Measures
- Padding and strapping of the foot can provide additional support 1
- Stretching exercises should be incorporated to reduce tension 2
- Patient education about proper foot care, appropriate footwear selection, and daily foot monitoring 1
Follow-Up and Escalation
If improvement occurs within 6 weeks, continue all initial treatments until symptoms fully resolve. 1, 2
If no improvement occurs after 6 weeks, referral to a podiatric foot and ankle surgeon is appropriate, while continuing initial conservative measures. 1, 2 Additional interventions at that stage may include: 1
- Customized orthotic devices 1
- Night splinting 1
- Limited corticosteroid injections (if appropriate based on specific diagnosis) 1
- Casting or fixed-ankle walker-type device 1
Common Pitfalls to Avoid
- Inadequate footwear modification: Continuing to use inappropriate footwear (flat shoes, walking barefoot) will perpetuate symptoms 1, 2
- Premature return to full activity: Patients must maintain activity modification until adequate symptom resolution 2
- Failure to address weight: If obesity is present, this must be discussed as a contributing factor to pain and disability 1