Differential Diagnosis for Right Ankle Injury

Given the patient's history of a right ankle injury from a roll two weeks ago and the current severe pain that prevents walking even with a walking boot, the following differential diagnoses are considered:

• Single Most Likely Diagnosis

  • Fracture Non-union or Malunion: The patient's inability to walk due to pain, even with a walking boot, suggests a possible complication in the healing process of the initial fracture. A non-union or malunion could be causing the significant pain and impairment.

• Other Likely Diagnoses

  • Complex Regional Pain Syndrome (CRPS): This condition can develop after an injury and is characterized by severe, persistent pain. The fact that the pain is severe enough to prevent walking suggests CRPS as a possible diagnosis.
  • Infection: An infection of the soft tissues or bone could cause increased pain and disability, especially if the initial injury became infected or if there was a complication with the walking boot.
  • Tendon or Ligament Injury: Beyond the initial fracture, injuries to the tendons or ligaments around the ankle could cause significant pain and instability, making it difficult to walk.

• Do Not Miss Diagnoses

  • Osteomyelitis: A bone infection that could arise from the initial trauma or subsequent complications. It's crucial to identify and treat osteomyelitis promptly to prevent long-term damage.
  • Deep Vein Thrombosis (DVT): Immobility and trauma increase the risk of DVT, which can be life-threatening if it leads to a pulmonary embolism.
  • Compartment Syndrome: Although less common two weeks post-injury, compartment syndrome is a medical emergency that requires immediate attention to prevent permanent damage.

• Rare Diagnoses

  • Tumor: A pathological fracture due to an underlying bone tumor is rare but could explain persistent pain and disability.
  • Neuropathic Pain: Conditions like nerve entrapment or neuropathy could cause severe, persistent pain but are less directly related to the initial trauma.
  • Gout or Pseudogout: Although these conditions are more commonly associated with joint pain, they could potentially cause severe pain in the ankle, especially if there's a history of these conditions.