“My Feet Are Killing Me”
Foot and ankle injuries account for an estimated 10–15% of all work-related musculoskeletal claims, yet they remain some of the most misunderstood and frequently delayed diagnoses in workers’ compensation. From construction sites and warehouses to healthcare settings, these injuries often appear “minor” at first—only to spiral into prolonged claims when early opportunities are missed.
So why do foot and ankle injuries so often become complicated? Dr. Wityk, Foot and Ankle specialist at Sano, breaks it down.
Why These Claims Go Off Track
Common contributors to delayed recovery include:
- Missed or incomplete diagnoses
- Inadequate immobilization early on
- Premature return to full duty
- Poor coordination between providers, therapy, employers, and adjusters
- Psychosocial and deconditioning factors
A “simple ankle sprain” is a prime example. Without careful attention to injury mechanism, weight-bearing tolerance, and instability, more serious conditions—like syndesmotic injuries, Lisfranc injuries, or talar cartilage lesions—can be overlooked.
Mechanism Matters
Understanding how the injury occurred often points directly to what the injury is. Inversion injuries, crush injuries, repetitive loading, prolonged standing, and falls from height all raise different red flags and should drive both imaging decisions and care pathways.
Early clinical evaluation should always assess:
- Ability to bear weight
- Location of swelling or bruising
- Signs of instability or tendon rupture
- Whether symptoms are improving—or plateauing
Persistent pain beyond expected timelines demands reassessment, not reassurance.
Imaging: Timing and Type Are Critical
Appropriate imaging is essential, but it must be used thoughtfully. Weight-bearing X-rays are vital for midfoot injuries, while CT scans clarify bone detail and MRI is best reserved for defining soft tissue injury—ideally after initial stabilization. Over-reliance on early MRI without correlating clinical findings can delay definitive care.
Treatment Success Starts with the Basics
Many work-related foot and ankle injuries respond well to conservative management when it’s done right:
- Proper immobilization (often longer than expected)
- Activity modification—not just rest
- Structured rehabilitation with progressive loading
- Clear, enforced work restrictions
Surgery is reserved for instability, fractures, tendon ruptures, or failure of conservative care, but when indicated, timely surgical intervention can prevent months of lost productivity.
Return to Work Is Treatment
Early, well-defined modified duty is one of the strongest predictors of successful outcomes. Workers who return in a light-duty capacity maintain conditioning, recover faster psychologically, and experience shorter claim durations. Restrictions must be clear—and followed.
Communication Is the Common Thread
The best outcomes in work-related foot and ankle injuries occur when physicians, therapists, employers, and adjusters communicate early and often. Clear expectations, realistic timelines, and regular reassessment keep everyone aligned and prevent minor setbacks from becoming major delays.
As Dr. Elliott Wityk explains:
“The best outcomes happen when everyone is aligned. Clear communication and realistic timelines prevent small setbacks from becoming major delays.”
— Elliott Wityk, DPM, FACFAS
When restrictions are clearly outlined—and adhered to—injured workers are more likely to progress confidently through rehabilitation, return to appropriate modified duty, and avoid unnecessary claim extensions.
