What is the best course of action for a 73-year-old female with chronic right ankle and lower leg pain, status post multiple surgeries, who is requesting a motorized scooter due to perceived bedbound status despite being able to ambulate?

Management of Chronic Right Ankle Pain with Limited Mobility

A comprehensive functional assessment and multidisciplinary approach is strongly recommended for this 73-year-old female veteran with chronic right ankle pain and limited mobility, rather than immediate provision of a motorized scooter.

Initial Assessment and Diagnosis

• Obtain detailed imaging of the right ankle, starting with standard radiography (anteroposterior, lateral, and mortise views) to evaluate osseous structures, evidence of prior trauma, osteoarthritis, and hardware complications from previous surgeries 1
• Consider MRI for comprehensive evaluation of soft tissue structures, including ligaments, tendons, and potential impingement syndromes if radiographs are inconclusive 1
• Assess for alternative diagnoses that may mimic ankle pain, including neurologic causes, spinal stenosis, or venous claudication 1
• Document functional capacity objectively, including walking distance, use of assistive devices, and ability to perform activities of daily living 1

Treatment Approach

• Before considering a motorized scooter, implement a structured rehabilitation program focusing on pain management, strengthening, and mobility improvement 1
• Provide appropriate orthotic devices (ankle braces, supportive shoes, or insoles) to improve stability and reduce pain during ambulation 1
• Consider pain management options including NSAIDs, physical therapy modalities, and potentially targeted injections based on imaging findings 1, 2
• Address sleep disturbances that may be exacerbating pain perception and limiting recovery 1

Mobility Assessment and Assistive Devices

• Since the patient can ambulate to the bathroom, bed, and kitchen, focus on improving this existing mobility rather than encouraging dependence on a motorized scooter 1
• Consider a less restrictive assistive device such as a walker or cane to maintain independence while providing support 1
• Evaluate for peripheral arterial disease as a potential contributor to lower extremity pain, especially given the patient's age and history 1

Special Considerations for Post-Surgical Ankle

• Assess for potential complications from hardware placement, including impingement syndrome (reported in up to 60% of certain risk groups) 3
• Evaluate for possible neuropathic pain, which affects approximately 23% of patients following open reduction and internal fixation of ankle fractures 4
• Consider chronic ligamentous instability as a potential cause of persistent symptoms, especially following multiple surgeries 5

Multidisciplinary Care

• Engage a multispecialty care team including podiatry, physical therapy, and pain management to address the complex nature of chronic post-surgical ankle pain 1
• Implement a supervised exercise program focusing on ankle mobility, strength, and proprioception 1
• Address psychological factors that may be contributing to pain perception and functional limitation 1

Follow-Up and Monitoring

• Establish clear functional goals and regularly reassess progress 1
• Document objective improvement in mobility and pain levels to guide ongoing treatment decisions 1
• Consider advanced imaging or specialist referral if no improvement is seen after 6-8 weeks of appropriate conservative treatment 2

Motorized Scooter Considerations

• Reserve motorized scooter prescription for patients with documented inability to ambulate despite appropriate conservative management and rehabilitation 1
• If mobility continues to decline despite interventions, consider a formal mobility assessment by physical and occupational therapy before prescribing powered mobility 1