Case
study:
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?
Analyze
the possible conditions from your colleagues’ differential diagnoses. Determine
which of the conditions you would reject and why. Identify the most likely
condition, and justify your reasoning.
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Colleague Post:
Differential diagnoses:
1)
Syndesmosis sprain, the sprain may result
from injury of ligaments connecting the tibia and fibula bones to the distal
fibular syndesmosis due to the physical act of playing soccer.
2) Ankle avulsion could also be a cause of ankle pain
resulting from a ligament pull of a bone fragment of the rest of the bone.
Sudden position changes among athletes and footballers could result in ankle
avulsion.
3) Ankle impingement is also a differential condition for
ankle pain (Mayo Clinic, 2021).
Athletes and footballers are likely to suffer
the anterior or posterior area ankle impingement from within, during the course
of physical activity.
4) Achilles tendinitis is also a possible differential diagnosis
for ankle pain. Injury in the Achilles tendon could exhibit symptoms of pain in
the ankle (Mayo Clinic, 2021). It is a risk factor among athletes in a soccer
game that calls for frequent physical activity of starting and stopping.
5) A stress fracture on the distal end of the tibia, fibula, or
talus is also a differential diagnosis of ankle pain. Intensive physical
activity in a soccer game could cause tiny cracks in any ankle bones.
Additionally, older people are at higher risk of stress fractures, unlike
younger people.
References
Rad, N. F.,
Yousefi-Koma, A., Tajdari, F., & Ayati, M. (2016, October). Design of a
novel three degrees of freedom ankle prosthesis inspired by human anatomy.
In 2016 4th International Conference on Robotics and
Mechatronics (ICROM) (pp. 428-432). IEEE.
Mayo Clinic. (2021, March
13). Ankle pain
causes. https://www.mayoclinic.org/symptoms/ankle-pain/basics/causes/sym-20050796
Stanford Medicine. (2021). Ankle and foot exam. Stanford Medicine 25. https://stanfordmedicine25.stanford.edu/the25/Ankleandfootexam.html
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