The 46-year-old female patient reports pain and discomfort in her right ankle. Because she can still bear her weight on the ankle, it is possible to conclude it is not fractured. The most likely cause is strenuous physical activity, which resulted in an ankle sprain. Other diagnoses I should take in account include Achilles tendinitis, plantar fasciitis, rheumatoid arthritis, and calcaneal spur because they can all be triggered by physical trauma (Seller & Symons, 2012).
When collecting the patient’s medical history, it is important to focus on previous athletic injuries and previous instances of painful joints because that can indicate possible joint inflammations, such as rheumatoid arthritis (Dains, Baumann, & Scheibel, 2012). Chronic disorders can also result in ankle pain. For example, if a patient has a history of diabetes, she could suffer from neuroarthropathy (Seller & Symons, 2012).
The physical examination will assess the ankle mobility and look for potential swellings and changes in skin color. For example, a swelling over the Achilles tendon indicates the patient has Achilles tendinitis. The palpation will inspect the ankle for fibromas, which are caused by soft tissue trauma, and the sensitivity of trigger points which indicate myofascial injuries (LeBlond, Brown, & DeGowin, 2009). Subcutaneous nodules surrounding the joint may also indicate rheumatoid arthritis (LeBlond et al., 2009).
If the physical examination finds subcutaneous nodules around the ankle, the rheumatoid factor test should be used before confirming the rheumatoid arthritis diagnosis (Dains et al., 2012). Because ankle sprain, plantar fasciitis, and calcaneal spur are the most likely diagnoses in acute physical trauma, radiography and magnetic resonance imaging (MRI) should be used. Radiography can detect micro-fractures I would otherwise overlook, and it can also show calcium deposits under the heel, which cause calcaneal spur (Seller & Symons, 2012). The MRI will detect plantar fasciitis because it shows soft tissue damage and possible nerve entrapments in the foot, which can cause chronic pain if left untreated after an injury (Seller & Symons, 2012).
References
Dains, J. E., Baumann, L. C., & Scheibel, P. (2012). Advanced health assessment and clinical diagnosis in primary care (4th ed.). St. Louis, MO: Mosby, Elsevier.
LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2009). DeGowin’s diagnostic examination (9th ed.). New York, NY: McGraw Hill Medical.
Seller, R. H., & Symons, A. B. (2012). Differential diagnosis of common complaints (6th ed.). Philadelphia, PA: W. B. Saunders Company.
