Ankle Pain/Swelling
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-525-6884
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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
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
References
Acknowledgements
The content on this page was first contributed by Editor-In-Chief: C. Michael Gibson, M.S., M.D. [3] Phone:617-525-6884
List of contributors:
Suggested Reading and Key General References
Suggested Links and Web Resources
For Patients
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
