Girl lacing up her gym shoeIf you are experiencing pain, there is a simple recommendation that you can start with on your own before your visit to the office. Pain in the feet and ankles is usually due to underling inflammation. Inflammation can be – but is not always – accompanied by swelling in the foot. We are on our feet all the time and whether you have had an injury of some kind or are just noticing pain that wasn’t there before, we recommend RICE. While the author loves the carb you may be thinking of right now – whether in sushi, under Chinese food, or even made into a snack – this isn’t the kind of rice we are talking about.

RICE is an acronym for rest, ice, compression and elevation. For an extremity suffering pain, this is a great way to start trying to mend yourself. I find it to be highly under rated. True, I have had several family members and friends who as what they should do because they started noticing a new pain in their foot and they think it’s a cop out when I say to rest, ice, compress and elevate, but it truly helps.

So the first part in this acronym is rest.

Foot elevated in splint with ace bandageWhether you have suffered an injury recently or started noticing generalized pain or aches, rest is a way to provide your body the opportunity to heal and repair damaged tissue. One of the most truly amazing things about my career is seeing how good our bodies are at fixing themselves – IF we give the body the opportunity. If you sprain your ankle and deny the existence of the injury, your body has to work all the more harder to try and heal and often not providing enough rest means that the condition will linger on longer than you want it to. In all honesty, many conditions would resolve if we sufficiently rested them for 2-3 weeks right from the get go.

Velcro walking boot

By rest, this can mean sitting with your foot up unless going to the bathroom or showering – 

something I recommend after foot surgery or if you have been diagnosed with a severe sprain or fracture. It can also mean providing something supportive to reduce stress, strain and pressure on an injured foot. If you have suffered an injury or are experiencing chronic tendinitis, we help to rest the damaged area with anything from ankle braces to CAM walker boots to splints or even casts if needed. Therefore, immobilization and reducing movement through the joints and tendons affected helps reduce pain by allowing the body to heal in a more controlled environment.

Ice is next in our acronym.

Icing is also very underrated. By applying ice to an affected area (of course protecting the skin from cold injury) causes vasoconstriction, meaning the blood vessels which are often dilated in injury and pumping more fluid to the area can be limited. This is beneficial with swelling and inflammation because by limiting the amount of fluid to the affected site will reduce stress on the tissues and reduces the pressure on nerves. The superficial nerves are also temporarily affected which improves analgesia effects on the spot. Icing should not be done continuously as this is harmful – too much of a good thing is no longer a good thing! By doing icing intermittently, you can actually give your blood vessels a bit of a workout as they will constrict with icing and then dilate during the time between your ice packs. This dilation-constriction pattern helps to pump fluid out of an injured area. To exaggerate this effect, there is also something called contrast therapy. This utilizes both heat and ice alternatively for an increased effect.Bruised ankle with ice pack

To properly ice, it is important to always have something to protect the skin (a towel/paper towel/sock/ACE wrap)-especially if you are using gel ice pack as these get colder. Also, timing is key. Icing for 10-15 minutes every hour on the hour is a great rule of thumb. When training in undergrad (kinesiology and athletic training) we were tough about CBAN. Yup, another acronym – sorry! Our athletes were made aware of CBAN so that they could ensure they were icing properly. ‘C’ stands for cold, which is what you will first feel when you put the ice on the affected area. After this, you will feel ‘B’ – burning. That’s right, this is part of the icing process. Next, the affected area started to feel ‘A’ achy. In the final stages of icing, the area will topically feel ‘N’ numb. This typically takes about 10-15 minutes and then you know you have successfully completed a session of icing. After this, if you are using frozen peas/corn or an actual ice pack, the ice pack will continue to increase in temperature/melt/thaw and so leaving it on you may not notice further effects, but it doesn’t have any additional benefit to leave it on any longer than this. So get C.B.A.N. – ing!

Picture of foot elevated on couch with ice and ace wrapBack to RICE, we will now discuss compression.

Compression – again a controlled amount that is not excessive – help to control pain. In cases of injury, some amount of compression helps to improve stability and even assists a bit in immobilization. Compression is most often going to be available at home in the form of an ace wrap or perhaps compression stocking. Our office also applies something called an Unna’s wrap for patients with swelling and pain and in cases of acute injury. This wrap consists of a zinc oxide impregnated gauze which feels soothing and cool to the skin and the second layer is coban. Coban is a stretching, self adhering bandaging material that can apply the desired amount of compression to help milk swelling out of an injured area. We typically recommend that the wrap stay on, clean and dry for 3-4 days as this helps to really get swelling down – thus controlling pain. Ace wraps typically should be applied/adjusted 2 times per day for fluctuations in swelling that can occur after an injury.

Picture of man with foot up and thumbs upFinally, elevation is important when treating a painful foot or ankle.

Gravity is awesome for a great number of things. When you have had an injury, however, gravity’s pull can increase swelling in a foot or ankle. Elevating helps to reduce swelling which will reduce the stretch of skin and soft tissues as well as nerves. The next question then is HOW should you elevate? How high specifically. Elevating at hip level in most cases is sufficient. Having the foot at hip level when at rest means that it is not dependent (hanging down) which is where gravity start to put more pull on fluids in the leg. If you can tolerate elevating higher than hip level during the day, one or two pillows should be sufficient for elevation.

So if RICE is so awesome, what times and for who is it a bad idea? Rest doesn’t seem like it would be back for anyone. However, with conditions like plantar fasciitis and even some tendinitis in the foot, too much rest or resting with the foot in a relaxed position can actually result in increased pain. Why? Because if a tendon or ligament is chronically inflamed, the body has a cyclical scaring process and if the collagen being formed is with the foot in a relaxed and non-functional position, it will need to be stretched/torn in order to allow for normal walking and ambulation. In most cases of tendinitis and fasciitis, we recommend regular activity and rest is more from high impact activities that can increase inflammation to the already aggravated tissue. The reason this is not usually a problem after an injury is because after seeking treatment, a brace or boot will help hold the foot/ankle in a neutral position where we WANT the collagen to form. This is good in those cases because it assists in restoring some stability to the damaged tissue.

Icing is again best done in moderation and with the skin protected. Another instance where icing is NOT a good idea is if a patient has a history of vascular insufficiency – their blood flow is compromised. This can be cases of Reynauds or cold hypersensitivity, but also patients who have poor pulses or who have undergone revascularization procedures. Constricting vessels in a patient who needs all the blood flow they can get is not a good idea.

picture of blood clot in veinCompression done in moderation is great for foot and ankle pain. An instance where it might not be good is if it is too tightly applied or if the condition is related to damaged nerves. In these cases, further pressure on the nerve can create more damage and result in pain and numbness. In cases of vascular insufficiency as described above, we also like to limit compression to the minimum necessary as pressure applied to vessels can close down the blood flow needed for healing.

Elevation in moderation can actually be OK for some levels of poor blood flow, especially if elevation is just at hip level. Typically if elevation is not good for you, your leg will let you know. A condition called rest pain may present. This is typically seen in the more elderly population where sleeping in bed at night pain will present in the legs and the best way to alleviate this is to dangle the leg. If pain is in your legs when in bed but improved with dangling the leg, having an evaluation is imperative to determine the cause of pain and address any blood flow issues.

So the beauty in RICE is that anybody can do it! Whether you have already been told to perform RICE after receiving a diagnosis from your doctor or you are waiting for your appointment after noticing pain in your foot and ankle, try RICE to alleviate some of your pain. Just remember, all should be done appropriately and not in excess and of course if any increases rather than alleviates pain, let your doctor know and discontinue at once! If you are reading through this and considering if you need an appointment, the answer is usually to call us! Pain in your feet and ankles should not be a reality. It is NOT normal to have foot and ankle pain, no matter what your neighbor/cousin/uncle tells you. There is a reason for the pain and most of those reasons have solutions!