Ankle Pain

Full Answer Section

  Anatomy of the Ankle The ankle is a complex joint that is made up of three bones: the talus, the tibia, and the fibula. The talus is the bone that sits on top of the tibia and fibula, and it is responsible for transferring weight from the foot to the leg. The tibia and fibula are the two long bones that run down the lower leg, and they provide stability to the ankle joint. Causes of Ankle Pain The most common cause of ankle pain is a sprain. A sprain occurs when the ligaments that support the ankle joint are stretched or torn. Sprains can be mild, moderate, or severe. Mild sprains typically heal on their own within a few weeks, while moderate and severe sprains may require more time to heal and may require physical therapy. Another common cause of ankle pain is a strain. A strain occurs when a muscle or tendon in the ankle is stretched or torn. Strains can also be mild, moderate, or severe. Mild strains typically heal on their own within a few weeks, while moderate and severe strains may require more time to heal and may require physical therapy. Fractures are another possible cause of ankle pain. Fractures can occur in any of the bones that make up the ankle joint. Fractures typically require medical attention and may require surgery. Tendinitis is another possible cause of ankle pain. Tendinitis occurs when a tendon in the ankle becomes inflamed. Tendinitis can be caused by overuse, injury, or other factors. Tendinitis typically heals on its own within a few weeks, but it may require rest, ice, compression, and elevation. Differential Diagnosis The differential diagnosis for ankle pain includes:

• Sprain
• Strain
• Fracture
• Tendinitis
• Bursitis
• Arthritis
• Infection
• Tumor

Physical Examination The physical examination of the patient with ankle pain should include:

• Inspection of the ankle for swelling, bruising, and deformity
• Palpation of the ankle for tenderness, warmth, and crepitus
• Range of motion testing of the ankle
• Special tests, such as the anterior drawer test and the talar tilt test, to assess for ligamentous instability

Special Maneuvers The anterior drawer test and the talar tilt test are two special maneuvers that can be used to assess for ligamentous instability of the ankle. The anterior drawer test is performed by passively pulling the front of the foot towards the shin. The talar tilt test is performed by passively tilting the talus forward and backward. Ottawa Ankle Rules The Ottawa ankle rules are a set of criteria that can be used to determine if a patient with ankle pain needs additional testing, such as an X-ray. The Ottawa ankle rules are as follows:

• Age > 50 years
• Inability to bear weight immediately after the injury
• Bone tenderness at the tip of the fibula
• Bone tenderness over the navicular bone

If the patient meets any of these criteria, they should be considered for further imaging. Conclusion Ankle pain is a common complaint that can be caused by a variety of conditions. The differential diagnosis for ankle pain is broad, and it is important to perform a thorough physical examination to determine the cause of the pain. The Ottawa ankle rules can be used to help determine if the patient needs further imaging.

Sample Answer

Ankle Pain Ankle pain is a common complaint that can be caused by a variety of conditions, including sprains, strains, fractures, and tendinitis. The pain can be sharp or dull, and it may be accompanied by swelling, bruising, and difficulty walking