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ankle pain

Etiology: (differential diagnosis) 1) ankle sprain 2) fracture a) tibia b) fibula c) osteochondral fracture d) 5th metatarsal 3) peroneal tendonitis 4) arthritis 5) nerve impingement 6) dislocation 7) subluxation 8) reflex sympathetic dystrophy 9) osteochondritis dessicans Clinical manifestations: 1) swelling, ecchymosis, erythema, mottled appearance may be apparent 2) range of motion may be restricted 3) palpable tenderness over bones, ligaments or tendons may be noted 4) neurovascular examination may be abnormal 5) anterior drawer test, talar tilt test, &/or compression test of tibia &/or fibula may be abnormal Radiology: 1) plain radiographs (AP, lateral, oblique) a) patient cannot bear weight b) fracture suspected c) bone pain localized to the lateral malleolus 2) bone scan for suspected stress fracture 3) computed tomography (CT) for suspected osteochondral lesion 4) 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 1) physical therapy a) aimed at improving motion, strength, flexibility & proprioception b) non-weight-bearing exercise early until weight-bearing no longer elicits pain & inflammatory phase subsides 2) peroneal tendon dysfunction a) peroneal tendon stretching b) lateral heel wedge c) ankle brace d) physical therapy e) surgery if indicated 4) pharmacologic agents a) non-steroidal anti-inflammatory Drugs (NSAIDs) b) class 4 narcotic agents 1] Vicodin 2] Darvocet 3] Percocet 4] tylenol #3 5) referral to anesthesiologist for sympathetic block 6) urgent referral to orthopedic surgeon if acute neurovascular impairment 7) referral or consultation for displaced ankle fracture, Jones fracture, peroneal tendon dislocation or osteochondritis dessicans

Related

Achilles tendon rupture/tear ankle ankle sprain foot pain leg pain

General

lower leg joint pain

References

  1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 751
  2. Medical Knowledge Self Assessment Program (MKSAP) 14, American College of Physicians, Philadelphia 2006