ankle pain
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Etiology
(differential diagnosis)
- ankle sprain
- fracture
- peroneal tendonitis
- arthritis
- nerve impingement
- dislocation
- subluxation
- reflex sympathetic dystrophy
- osteochondritis dessicans
Clinical manifestations
- swelling, ecchymosis, erythema, mottled appearance may be apparent
- range of motion may be restricted
- palpable tenderness over bones, ligaments or tendons may be noted
- neurovascular examination may be abnormal
- anterior drawer test, talar tilt test, &/or compression test of tibia &/or fibula may be abnormal
Radiology
- plain radiographs (AP, lateral, oblique)
- patient cannot bear weight
- fracture suspected
- bone pain localized to the lateral malleolus
- bone scan for suspected stress fracture
- computed tomography (CT) for suspected osteochondral lesion
- magnetic resonance imaging (MRI) for soft tissue pathology or osteochondral lesions
Management
R: rest from pain-eliciting activities
I: ice for 20 minutes several times/day while area is swollen
C: compression with padding & a wrap
E: elevation above level of heart to reduce edema
D: non-steroidal anti-inflammatory Drugs (NSAIDs) for pain & inflammation if not contraindicated
- physical therapy
- aimed at improving motion, strength, flexibility & proprioception
- non-weight-bearing exercise early until weight-bearing no longer elicits pain & inflammatory phase subsides
- peroneal tendon dysfunction
- peroneal tendon stretching
- lateral heel wedge
- ankle brace
- physical therapy
- surgery if indicated
- pharmacologic agents
- referral to anesthesiologist for sympathetic block
- urgent referral to orthopedic surgeon if acute neurovascular impairment
- referral or consultation for displaced ankle fracture, Jones fracture, peroneal tendon dislocation or osteochondritis dessicans