Differential Diagnosis for Ankle Pain in a 26-year-old Football Player
Single Most Likely Diagnosis
- Ankle Sprain: This is the most common injury in football, and the mechanism of injury (playing football) along with the symptom of ankle pain makes it highly likely. Ankle sprains occur when the ligaments surrounding the ankle joint are stretched or torn.
Other Likely Diagnoses
- Stress Fracture: Overuse or repetitive stress from playing football can lead to stress fractures, especially in the bones of the lower leg and foot. Pain that worsens with activity and improves with rest is a common symptom.
- Achilles Tendinitis: Inflammation of the Achilles tendon, which connects the calf muscles to the heel bone, can cause pain in the back of the ankle. This condition is common in athletes who participate in sports that involve running and jumping.
- Peroneal Tendinitis: The peroneal tendons run along the outside of the ankle and can become inflamed due to overuse, leading to pain on the outside of the ankle.
Do Not Miss Diagnoses
- Osteochondral Lesion of the Talus (OLT): A potentially serious condition where a piece of cartilage and bone in the talus (ankle bone) becomes damaged. If missed, it can lead to chronic pain, arthritis, and significant disability.
- Compartment Syndrome: A condition where pressure within the muscle compartments increases, potentially cutting off blood flow. This is a medical emergency that requires immediate attention to prevent permanent damage.
- Septic Arthritis: Bacterial infection within the joint, which is a medical emergency requiring prompt antibiotic treatment to prevent joint destruction.
Rare Diagnoses
- Gout: Although more common in older adults, gout can occur in younger individuals, especially with a family history. It causes sudden, severe joint pain, often in the big toe but can affect the ankle.
- Pseudogout (Calcium Pyrophosphate Deposition Disease, CPPD): Similar to gout, pseudogout is caused by deposits of calcium pyrophosphate dihydrate crystals within the joint, leading to sudden, severe pain.
- Osteoid Osteoma: A benign bone tumor that can cause nocturnal pain, which is relieved by nonsteroidal anti-inflammatory drugs (NSAIDs). It's rare but should be considered in cases of persistent, unexplained bone pain.