Differential Diagnosis for Limited Ankle ROM with Posterior Malleolar Pain
Single Most Likely Diagnosis
- Ankle Impingement Syndrome: This condition is characterized by limited ankle range of motion and pain, especially with activities that involve dorsiflexion, such as walking. The posterior malleolar pain without bony tenderness on palpation, occurring after a jumping injury from snowboarding, supports this diagnosis. The mechanism of injury and the symptoms presented align well with ankle impingement syndrome, which can result from repetitive microtrauma or acute injuries.
Other Likely Diagnoses
- Peroneal Tendinopathy: Inflammation or degeneration of the peroneal tendons, which run behind the lateral malleolus and could refer pain to the posterior aspect of the ankle, making this a plausible diagnosis given the location of pain and the mechanism of injury.
- Posterior Ankle Capsulitis: This condition involves inflammation of the posterior ankle capsule and can cause pain and limited mobility, similar to what is described. It could be a result of the snowboarding injury.
- Flexor Hallucis Longus (FHL) Tendinopathy: The FHL tendon runs posterior to the ankle and can cause posterior ankle pain when inflamed or irritated, which could be consistent with the symptoms described, especially if the injury involved forced dorsiflexion.
Do Not Miss Diagnoses
- Osteochondral Lesion of the Talus: Although less likely, an osteochondral lesion (a piece of cartilage and bone that has been damaged) could present with deep ankle pain and limited range of motion without significant bony tenderness on palpation. Missing this diagnosis could lead to chronic pain and potentially necessitate surgical intervention.
- Deep Vein Thrombosis (DVT): While DVT typically presents with swelling, redness, and warmth of the affected limb, in some cases, especially if the clot is located more proximally, it might only cause pain, especially with activity. Given the potential severity of a DVT, it's crucial not to miss this diagnosis.
Rare Diagnoses
- Tarsal Tunnel Syndrome: This involves compression of the posterior tibial nerve as it travels through the tarsal tunnel on the inner side of the ankle. While it could cause pain and potentially some limitation in ankle mobility due to discomfort, it's less directly related to the mechanism of injury and symptoms described.
- Stress Fracture of the Talus or Calcaneus: Although a stress fracture could present with pain and limited mobility, the absence of bony tenderness on palpation and the specific location of pain make this less likely. However, stress fractures can sometimes have atypical presentations, making them a consideration in the differential diagnosis.