Title: Ankle-foot complex pain in primary care: An evidence-based approach
Abstract:
Ankle-foot complex pain is among the most common musculoskeletal complaints encountered in primary care and advanced practice settings, affecting mobility, physical function, occupational performance, and overall quality of life. Nurse practitioners are frequently the first healthcare providers to evaluate patients with foot and ankle pain; however, the region's intricate anatomy and broad differential diagnosis can make accurate assessment and management challenging. Delayed or missed diagnoses may result in chronic pain, prolonged disability, tendon rupture, progressive deformity, or stress fracture progression. As healthcare systems emphasize early intervention, conservative management, and prevention of disability, advanced practice nurses must possess a systematic and evidence-based approach to ankle-foot evaluation. This presentation provides a practical framework for assessing and managing ankle-foot complex pain in primary care populations. Participants will review relevant anatomy, biomechanics, and common pain patterns to facilitate clinical reasoning and diagnostic accuracy. A structured history and focused physical examination approach will be presented, emphasizing localization of symptoms, identification of risk factors, and recognition of red-flag findings that warrant urgent referral or advanced imaging. Common conditions encountered in primary care—including plantar fasciitis, Achilles tendinopathy, ankle sprains, posterior tibial tendon dysfunction, stress fractures, and forefoot disorders—will be discussed using current evidence-based guidelines. Special attention will be given to the appropriate use of diagnostic imaging, including application of the Ottawa Ankle Rules, indications for radiography, ultrasound, and magnetic resonance imaging, and strategies for avoiding unnecessary testing. Evidence supporting conservative treatment modalities such as therapeutic exercise, orthotics, physical therapy, activity modification, and extracorporeal shockwave therapy will be reviewed. Emerging interventions and areas of ongoing investigation will also be explored. In addition to clinical management, the presentation will highlight opportunities for nursing research related to musculoskeletal screening, injury prevention, telehealth assessment, wearable technologies, and implementation of evidence-based care pathways. Through case-based learning and application of current literature, participants will gain practical tools to improve diagnostic confidence, optimize patient outcomes, and identify future directions for research in ankle-foot health. This session is designed for nurse practitioners, advanced practice nurses, nurse educators, and nursing researchers seeking to strengthen musculoskeletal assessment and management skills in primary care practice.
