From the Research
The patient's diagnosis is likely ankle osteoarthritis with possible atherosclerosis, and treatment should begin with conservative measures including rest, ice, compression, and elevation (RICE protocol) for acute pain management, as recommended by 1. The patient should take NSAIDs such as ibuprofen 400-600mg three times daily with food or naproxen 500mg twice daily for 1-2 weeks to reduce inflammation and pain. Weight management is essential to reduce stress on the joint. Physical therapy focusing on ankle strengthening and range of motion exercises should be initiated, with sessions 2-3 times weekly for 4-6 weeks, as suggested by 2 and 3. Supportive footwear with cushioning and possibly custom orthotics can provide stability. For persistent pain, a corticosteroid injection (such as methylprednisolone 40mg with lidocaine) may provide temporary relief, as seen in 4. The talar beak and malleolar spurring indicate degenerative changes consistent with osteoarthritis, while atherosclerosis suggests vascular disease that may contribute to healing challenges. If conservative treatment fails after 3-6 months, surgical options including arthroscopic debridement or, in severe cases, ankle fusion or replacement may be considered, as discussed in 5. The patient should also be evaluated by a vascular specialist to address the atherosclerosis with appropriate cardiovascular risk factor modification. Some key points to consider in the treatment plan include:
- Using cryotherapy for the first three to seven days to reduce pain and improve recovery time, as recommended by 1
- Wearing a lace-up ankle support or an air stirrup brace combined with an elastic compression wrap to reduce swelling and pain, as suggested by 1
- Early mobilization to speed healing and reduce pain, as seen in 3 and 1
- Considering ankle braces and supports, ankle taping, a focused neuromuscular training program, and regular sport-specific warm-up exercises to protect against ankle injuries, as discussed in 1