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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.
Differential Diagnoses (DD) colleagues DD below
Ankle Sprain (grade II): is an injury involving the anterior talofibular ligament resulting in stretching or microscopic tears of the stabilizing ligaments. This injury is common in sports and symptoms include some loss of function, positive anterior drawer test, bruising, point tenderness, decreased total ankle motion and swelling (Well et al., 2019)
Achilles tendon rupture: is the largest and most frequently torn tendon in the human body. Achilles tendon injuries are among the most common sport-related injuries. A popping sound may occur at the time of injury and Pain and swelling present near the heel (Reiman et al., 2014).
Ankle Fracture: is an injury of the bone creating a break. It is common in sports and causes immediate, throbbing pain, swelling, bruising, tenderness, deformity, difficulty or pain with walking, or bearing weight (Polzer et al., 2012).
Achilles tendinopathy: Achilles tendon injuries are among the most common sport-related injuries. Pain and swelling will be present where the tendon inserts into the calcaneus, and patients report tightness (Reiman et al., 2014).
Plantar fasciitis: an inflammation of a thick band of tissue that connects the heel bone to the toes. It affects woman twice as often as men and is caused by chronic weight-bearing stress. Pain occurs on the bottom of the heel, increases after exercise and is swollen (Schwartz & Su, 2014).
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