Medication Summary
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
Class Summary
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.
Ibuprofen (Motrin, Ibuprin)
Classified as a propionic acid derivative. All drugs in this class are effective inhibitors of cyclooxygenase, although the potency varies.
Naproxen (Naprelan, Naprosyn, Anaprox)
Classified as a propionic acid derivative. All the drugs in this class are effective inhibitors of cyclooxygenase, though the potency varies.
Cyclooxygenase-2 Inhibitors
Class Summary
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 Rofecoxib (Vioxx) was withdrawn from the worldwide market because of its association with and increased rate of cardiovascular events (including heart attack and stroke) compared with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.
Celecoxib (Celebrex)
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.
Analgesic, Miscellaneous
Class Summary
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.
Acetaminophen (Tylenol, Feverall, Aspirin Free Anacin)
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.
Hydrocodone and acetaminophen (Vicodin, Norcet, Lortab)
Drug combination indicated for moderate to severe pain for pain that is refractory to NSAIDs.
Codeine and acetaminophen (Tylenol #3, Tylenol Elixir with Codeine)
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.
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The hindfoot is composed of the talus and the calcaneus.
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Select tendons of the foot.
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Select bones of the foot (dorsal and plantar views).
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Select bones of the foot (medial and lateral views).
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Select bones of the foot (superolateral view).
