Question

A 46-year-old female reports pain in both of her ankles, but she is more concerned about her right ankle. She was playing soccer over the weekend and heard a "pop." She is able to bear weight, but it is uncomfortable. In determining the cause of the ankle pain, based on your knowledge of anatomy, what foot structures are likely involved? What other symptoms need to be explored? What are your differential diagnoses for ankle pain? What physical examination will you perform? What special maneuvers will you perform? Should you apply the Ottawa ankle rules to determine if you need additional testing?

Answer 1

She is able to walk and it means she didn't break her ankles.It can be a sprain or minor fracture.A popping sound in the angle indicates it is a ankle sprain not  ankle fracture.Sprain occurs when ligaments stretch beyond their possibility.Depending on the damage pain can vary from mild to severe form.Ankle sprain is common injury while playing sports .Excessive twisting or turning of ankle may injure the ligaments .An unstable ankle can make popping sound.Sprains can happen due to inversion or inward rolling. Popping sound indicates that a ligament has torn or ruptured.The most common type of ankle sprain is lateral ankle sprain.The foot roll inward and can damage ligaments of outer ankle the anterior talofibular ligament,the calcaneofibular ligament and posterior talofibular ligament.

The symptoms of ankle sprain are pain,bruising ,tenderness when you touch the ankle, instability in the ankle.and swelling.

Differential Diagnosis of Ankle sprain:1.Achilles tendon injury 2.Fracture of the base of the fifth metatarsal 3.Lateral collateral ligament injury 4.Medial collateral ligament injury 5.Tendon injury 6.Talar neck fracture 7.syndesmosis ligament injury.

Physical Examination;Observe the ankle and look for swelling,ecchymosis or any deformities.Identify the site of pain.Check the areas where bony and ligamentous injury can occur like lateral and medial malleoli,deltoid ligament,talofibular ligaments and Achilles tendon.Check base of fifth metatarsal ,entire tibia for any injuries.Range of motions can be assessesed like plantarflexion,dorsiflexion ,inversion and eversion.Asess patients ability to bear weight.

In Ankle sprain following tests are used:1.Anterior drawer test is used to assess ankle instability 2. Prone anterior drawing test is used to assess ligamentous instability.3. Talat tilt test is used to assess integrity of calcaneofibular ligament.

Yes will apply Ottawa Ankle Rules if additional testing is needed.Ottawa ankle rules are set of guidelines for physicians to decide whether patient with ankle pain need xrays to diagnose a possible bone fracture.A ankle x-ray is needed if there is bony tenderness at the tip of lateral mallelous or bone tenderness at tip of medial malleolus or inability to bear weight.