Management of Atraumatic Ankle Swelling and Tenderness
This patient requires evaluation for non-traumatic causes of ankle swelling, including inflammatory arthropathy, infection, or crystal arthropathy, rather than standard ankle sprain treatment protocols. The absence of trauma history, combined with preserved full active range of motion and no erythema or fever, suggests this is not a typical ankle sprain and warrants a different diagnostic approach.
Key Clinical Distinction
The presentation described does not fit the typical acute ankle sprain pattern:
- Ankle sprains require a mechanism of injury (typically inversion in plantar-flexed position) 1
- The absence of trauma history excludes standard sprain protocols 1
- Full active ROM is unusual for acute ligamentous injury, which typically causes significant functional limitation 1
Recommended Diagnostic Approach
Immediate evaluation should focus on:
- Rule out septic arthritis - Although fever and erythema are absent, septic arthritis can present with isolated joint swelling and tenderness; this is a cannot-miss diagnosis requiring urgent evaluation 1
- Assess for inflammatory arthropathy - Conditions like gout, pseudogout, or rheumatoid arthritis commonly present with atraumatic joint swelling in middle-aged adults 1
- Consider deep vein thrombosis - Unilateral ankle swelling without trauma warrants consideration of venous pathology 1
Initial Management Pending Diagnosis
Symptomatic relief measures:
- Avoid activities that cause pain and seek medical attention for definitive diagnosis 1
- NSAIDs may be considered for pain and swelling control while awaiting evaluation 1
- Ice application (20-30 minutes per application, ice and water mixture in damp cloth, avoiding direct skin contact) can provide symptomatic relief 1, 2
- Elevation to reduce swelling 1
Critical Pitfall to Avoid
Do not apply standard RICE or ankle sprain protocols without establishing a traumatic mechanism of injury. The Ottawa Ankle Rules and standard sprain management are designed specifically for acute traumatic injuries 1. Applying these protocols to non-traumatic swelling may delay diagnosis of serious conditions like infection, inflammatory arthritis, or venous thrombosis.
Urgent Referral Indications
Seek immediate medical evaluation if:
- Inability to bear weight develops 1
- Systemic symptoms emerge (fever, malaise) 1
- Rapid progression of swelling 1
- Development of erythema suggesting infection 1
The priority is establishing the underlying diagnosis rather than empiric treatment, as management depends entirely on the etiology of the atraumatic ankle swelling.