Differential Diagnosis for Pain above Foot on the Medial Side

Single Most Likely Diagnosis

• Medial ankle sprain: This is a common injury that occurs when the ligaments on the medial (inner) side of the ankle are stretched or torn, often due to rolling or twisting of the ankle. The pain is typically localized to the medial side of the ankle.

Other Likely Diagnoses

• Tendinitis of the tibialis posterior tendon: This condition involves inflammation of the tendon that supports the arch of the foot and is located on the medial side of the ankle. It can cause pain and swelling in the area.
• Medial ankle impingement: This condition occurs when soft tissue (such as ligaments or tendons) becomes pinched between the bones of the ankle, leading to pain on the medial side.
• Stress fracture of the medial malleolus or talus: A stress fracture is a small crack in a bone, often caused by overuse or repetitive stress. The medial malleolus (the bump on the inner side of the ankle) and talus (a bone in the ankle joint) are potential sites for stress fractures that could cause pain on the medial side of the ankle.

Do Not Miss Diagnoses

• Compartment syndrome: Although less common, compartment syndrome is a serious condition that occurs when pressure within the muscle compartments increases, potentially cutting off blood flow. It requires immediate medical attention and can present with pain, especially on the medial side if the deep posterior compartment is involved.
• Deep vein thrombosis (DVT): DVT is a blood clot that forms in a deep vein, typically in the legs. While it more commonly presents with swelling and pain in the calf, it can occasionally cause pain in the ankle area and is a critical diagnosis not to miss due to the risk of pulmonary embolism.
• Osteomyelitis or septic arthritis: Infections of the bone (osteomyelitis) or joint (septic arthritis) are serious conditions that can cause pain, swelling, and redness. They require prompt diagnosis and treatment to prevent long-term damage.

Rare Diagnoses

• Tarsal tunnel syndrome: This is a rare condition that involves compression of the posterior tibial nerve as it travels through the tarsal tunnel on the inner side of the ankle. It can cause pain, numbness, and tingling in the foot.
• Ganglion cyst: A ganglion cyst is a noncancerous lump that can develop on the medial side of the ankle, causing pain and discomfort.
• Bone tumors: Although rare, tumors of the bone (such as osteoid osteoma or osteosarcoma) can occur in the ankle region and cause localized pain.