Athletic Foot Injuries Medication
- Author: Timothy J Rupp, MD, MBA, FACEP, FAAEM; Chief Editor: Craig C Young, MD more...
NSAIDs remain the mainstays of medical therapy for athletic foot injuries. For moderate to severe pain, the addition of an opioid analgesic may be necessary as well.
Nonsteroidal Anti-inflammatory Drugs
NSAIDs have analgesic, anti-inflammatory, and antipyretic activities. The mechanism of action of these agents is not known, but they may inhibit cyclooxygenase activity and prostaglandin synthesis. Other mechanisms may exist as well; these may include inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell-membrane functions.
Classified as a propionic acid derivative. All drugs in this class are effective inhibitors of cyclooxygenase, although the potency varies.
Classified as a propionic acid derivative. All the drugs in this class are effective inhibitors of cyclooxygenase, though the potency varies.
COX-2 inhibitors promote control of moderate pain and anti-inflammatory effects, especially in patients who have sensitivity to the traditional NSAIDs. These agents appear to be as effective as nonselective NSAIDs in treating pain and inflammation, and their theoretic advantage over nonselective NSAIDs involves significantly less toxicity, particularly in the gastrointestinal (GI) tract. This class of drug generally is indicated for patients at risk for GI hemorrhage. These patients include those with peptic ulcer disease, patients on warfarin therapy or on concomitant steroids, and elderly persons.
There has been literature questioning the safety of COX-2 inhibitors. Rofecoxib (Vioxx) was withdrawn from the worldwide market because of its association with and increased rate of cardiovascular events (including heart attack and stroke) compared with placebo. Valdecoxib (Bextra) was recalled for similar concerns. It is not clear whether these safety concerns are specific to rofecoxib and valdecoxib.
Although increased cost can be a negative factor, the incidence of costly and potentially fatal GI bleeding is clearly less with COX-2 inhibitors than with the traditional NSAIDs. The cardiovascular issues may be a class effect of all COX-2 inhibitors. Ongoing analysis of the cost avoidance of GI bleeding and further study of the cardiovascular issues should further define the populations that will benefit from the use of and help to answer questions concerning the safety of COX-2 inhibitors.
Primarily inhibits COX-2, which is considered an inducible isoenzyme, induced by pain and inflammatory stimuli. Inhibition of COX-1 may contribute to NSAID GI toxicity. At therapeutic concentrations, COX-1 isoenzyme is not inhibited; thus, GI toxicity may be decreased. Seek the lowest dose of celecoxib for each patient. Celecoxib has the same general class labeling as conventional NSAIDs.
Pain control is essential to quality patient care. Analgesics ensure patient comfort and have sedating properties, which are beneficial for patients who are in pain. Opioids produce their major effects by acting as agonists on specific opioid receptors. The effects are diverse and include analgesia, drowsiness, respiratory depression, decreased GI motility, nausea, and vomiting.
Has analgesic and antipyretic effects that do not differ significantly from aspirin. However, acetaminophen has only weak anti-inflammatory effects. The exact mechanism of action is not clear.
Drug combination indicated for moderate to severe pain for pain that is refractory to NSAIDs.
Indicated for the treatment of mild to moderate pain. The elixir formulation has 12 mg of codeine combined with 120 mg of acetaminophen in 5 mL. Tylenol #3 has 300 mg acetaminophen and codeine phosphate 30 mg.
Malanga GA, Ramirez-Del Toro JA. Common injuries of the foot and ankle in the child and adolescent athlete. Phys Med Rehabil Clin N Am. 2008 May. 19(2):347-71, ix. [Medline].
Birrer RB, Dellacorte MP, Grisafi PJ. Common Foot Problems in Primary Care. 2nd ed. Philadelphia, Pa: Hanley & Belfus Inc; 1998.
Sammarco GJ, Cooper PS. Foot and Ankle Manual. 2nd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 1998.
Scurran BL. Foot and Ankle Trauma. 2nd ed. New York, NY: Churchill Livingstone; 1996.
Cailliet R. Foot and Ankle Pain. 3rd ed. Philadelphia, Pa: FA Davis Co; 1997.
Weinfeld SB, Haddad SL, Myerson MS. Metatarsal stress fractures. Clin Sports Med. 1997 Apr. 16(2):319-38. [Medline].
Knapp TP, Garrett WE Jr. Stress fractures: general concepts. Clin Sports Med. 1997 Apr. 16(2):339-56. [Medline].
DeLee JC, Evans JP, Julian J. Stress fracture of the fifth metatarsal. Am J Sports Med. 1983 Sep-Oct. 11(5):349-53. [Medline].
Maitra RS, Johnson DL. Stress fractures. Clinical history and physical examination. Clin Sports Med. 1997 Apr. 16(2):259-74. [Medline].
Stiell IG, Greenberg GH, McKnight RD, et al. Decision rules for the use of radiography in acute ankle injuries. Refinement and prospective validation. JAMA. 1993 Mar 3. 269(9):1127-32. [Medline].
Rachel JN, Williams JB, Sawyer JR, Warner WC, Kelly DM. Is radiographic evaluation necessary in children with a clinical diagnosis of calcaneal apophysitis (sever disease)?. J Pediatr Orthop. 2011 Jul-Aug. 31 (5):548-50. [Medline].
Richardson DR, Dean EM. The recurrent Morton neuroma: what now?. Foot Ankle Clin. 2014 Sep. 19 (3):437-49. [Medline].
Rupp T, Hancock R. Evaluation and management of foot pain in the emergency department. Emerg Med Rep. Jan 22 2007. 28(3):
Simon RR, Koenigsknecht SJ. Tarsometatarsal fracture-dislocations. Emergency Orthopedics: The Extremities. 3rd ed. Norwalk, Conn: Appleton & Lange; 1995. 331-2.
Hesp WL, van der Werken C, Goris RJ. Lisfranc dislocations: fractures and/or dislocations through the tarso-metatarsal joints. Injury. 1984 Jan. 15(4):261-6. [Medline].
Lenczner EM, Waddell JP, Graham JD. Tarsal-metatarsal (Lisfranc) dislocation. J Trauma. 1974 Dec. 14(12):1012-20. [Medline].
Germann CA, Perron AD, Miller MD, Powell SM, Brady WJ. Orthopedic pitfalls in the ED: calcaneal fractures. Am J Emerg Med. 2004 Nov. 22(7):607-11. [Medline].
Griffin D, Parsons N, Shaw E, Kulikov Y, Hutchinson C, Thorogood M, et al. Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus: randomised controlled trial. BMJ. 2014 Jul 24. 349:g4483. [Medline].
Hsu AR. Topical review: barefoot running. Foot Ankle Int. 2012 Sep. 33(9):787-94. [Medline].
Lieberman DE. What we can learn about running from barefoot running: an evolutionary medical perspective. Exerc Sport Sci Rev. 2012 Apr. 40(2):63-72. [Medline].
Rixe JA, Gallo RA, Silvis ML. The barefoot debate: can minimalist shoes reduce running-related injuries?. Curr Sports Med Rep. 2012 May-Jun. 11(3):160-5. [Medline].
Altman AR, Davis IS. Barefoot running: biomechanics and implications for running injuries. Curr Sports Med Rep. 2012 Sep-Oct. 11(5):244-50. [Medline].
Conti SF. Posterior tibial tendon problems in athletes. Orthop Clin North Am. 1994 Jan. 25(1):109-21. [Medline].
Gellman R, Burns S. Walking aches and running pains. Injuries of the foot and ankle. Prim Care. 1996 Jun. 23(2):263-80. [Medline].
Gilman AG, Rall TW, Nies AS, Taylor P, eds. Goodman and Gilman's the Pharmacological Basis of Therapeutics. 8th ed. New York, NY: McGraw Hill Inc; 1993. 489-500, 664-667.
Haverstock BD. Foot and ankle imaging in the athlete. Clin Podiatr Med Surg. 2008 Apr. 25(2):249-62, vi-vii. [Medline].
Jenkins WL, Raedeke SG, Williams DS 3rd. The relationship between the use of foot orthoses and knee ligament injury in female collegiate basketball players. J Am Podiatr Med Assoc. 2008 May-Jun. 98(3):207-11. [Medline].
Nunan PJ, Giesy BD. Management of Morton's neuroma in athletes. Clin Podiatr Med Surg. 1997 Jul. 14(3):489-501. [Medline].
Sims EL, Hardaker WM, Queen RM. Gender differences in plantar loading during three soccer-specific tasks. Br J Sports Med. 2008 Apr. 42(4):272-7. [Medline].
Wedmore IS, Charette J. Emergency department evaluation and treatment of ankle and foot injuries. Emerg Med Clin North Am. 2000 Feb. 18(1):85-113, vi. [Medline].
Wu KK. Morton neuroma and metatarsalgia. Curr Opin Rheumatol. 2000 Mar. 12(2):131-42. [Medline].