My Hole Ankle Hurts!

Author: Emily Rowe, Stephen Ojo / Editor: Nick Tilbury / Codes: MuP2, SLO1 / Published: 07/10/2021

A 26-year-old male presents to the Emergency Department (ED) with non-traumatic ankle pain. The pain woke him from sleep earlier and was not relieved by analgesia.

S-Anterior left ankle joint
O-Gradual, over the last 4 months
C-Sharp, Intermittent
R-Down the foot, and around the ankle
A-Nil
T-Constant
E-Weight-bearing
S-Severe

Being a keen drummer, he thinks the pain started after an intense practice session where his ankle was suspended in the dorsiflexed position for an extended period of time.

The GP diagnosed tendonitis and he has been seeing a physiotherapist regularly, with little effect on easing his pain or on his mobility.

There is no history of weight loss, night sweats, coughs, colds or fevers. He has a past medical history of Acute Lymphoblastic Leukaemia (ALL) at a young age which was treated successfully.

On examination, he is unable to weight- bear. His vital signs are normal with NEWS2= 0 and he looks well.

There is a mild swelling over the anterior joint line but no bruising, erythema or deformities. There is global tenderness over ankle joint but maximal tenderness is over the anterior joint line, medial malleolus and navicular. There is a reduced range on all movements due to increasing pain. The limb is neurovascularly intact.

Laboratory investigations (FBC, UE, CRP, ESR) are all within normal range.

An ankle x-ray is requested.