Ankle pain and swelling

Ankle pain and swelling
Normal ankle; Lateral view. Image courtesy of RadsWiki

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Contributors: Cafer Zorkun M.D., PhD.

Overview

• Common problem that occurs secondary to a chronic or an acute injury or degenerative disease.
• Ankle sprains are the most common cause of ankle pain.

  • Ankle sprain are generally a traumatic inversion injury

• Bilateral ankle swelling can be indicative of cardiac or vascular etiologies rather than intrinsic foot/ankle disease

Differential Diagnosis

• Avulsion fracture of the distal fibula
• Bimalleolar fracture
• Degenerative joint disease
• Diabetic arthropathy (Charcot's)
• Inversion sprain
• Inversion/eversion injury of subtalar joint
• Neoplasm
• Peroneal nerve entrapment
• Poor shoe alignment
• Repetitive injury with disruption of the ankle retinaculum
• Syndesmosis injury
• Trimalleolar fracture

Physical Examination

• Complete physical including ankle, foot, lower leg examination
• Pulses
• Neurovascular status
• Color
• Capillary refill

X-Ray

• Ottawa ankle rules determine necessity of ankle x-ray following trauma

  1. Tender proximal fifth metatarsal
  2. Tenderness of distal 6 cm of the fibula or tibia
  3. Tender navicular area
  4. Cannot bear weight (at least 4 steps)

• Lateral x-rays if needed
• Three-view ankle x-rays
• Stress views
• Foot series
• Lower leg series

Images courtesy of RadsWiki

• 
  Normal ankle; Lateral
• 
  Normal ankle; Oblique
• 
  Normal ankle; AP

MRI and CT

• CT and MRI if indicated

Other Diagnostic Studies

• Anterior/posterior drawer test
• Range of motion and muscle strength

Treatment

Mnemonics for treatment of ancle pain and swelling.

• PRINCE

  • Protection
  • Rest
  • Ice
  • NSAIDs (nonsteriodal anti-inflammatory drugs)
  • Compression
  • Elevation

• Casting if necessary
• To improve range of motion and muscle strength, physical therapy is often recommended

Surgery and Device Based Therapy

• Bracing ankle/foot may prevent reinjury
• Surgery may be necessary for certain fractures

Acknowledgements

The content on this page was first contributed by Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]

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