Ankle pain and swelling

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
 * Tender proximal fifth metatarsal
 * Tenderness of distal 6 cm of the fibula or tibia
 * Tender navicular area
 * 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

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