Differential Diagnosis for Right Ankle Pain
- The patient presents with right ankle pain, which worsened with weightbearing and improved with ice and ibuprofen. The following differential diagnoses are considered:
Single Most Likely Diagnosis
- Ankle Sprain: The patient's symptoms of ankle pain, worsened by weightbearing, and point tenderness anterior and lateral ankle are consistent with an ankle sprain. Although she reports no known injury, the repetitive strain from carrying boxes up and down stairs may have caused a minor sprain.
Other Likely Diagnoses
- Peroneal Tendinitis: The patient's pain location (anterior and lateral ankle) and relief with walking on her heel suggest peroneal tendinitis, which is common in individuals who engage in repetitive ankle movements.
- Achilles Tendinitis: Although the pain is not exclusively posterior, Achilles tendinitis is a possibility, especially given the patient's age and activity level. The mild relief with walking on her heel may also be seen in Achilles tendinitis.
- Stress Fracture: The patient's symptoms of worsening pain with weightbearing and point tenderness raise the possibility of a stress fracture, particularly in the distal fibula or talus.
Do Not Miss Diagnoses
- Septic Arthritis: Although less likely, septic arthritis is a potentially life-threatening condition that requires prompt diagnosis and treatment. The patient's symptoms of pain, swelling, and point tenderness could be indicative of septic arthritis, especially if she has a history of joint problems or immunocompromising conditions.
- Osteonecrosis: Osteonecrosis of the talus or other ankle bones is a rare but serious condition that can cause severe pain and disability. The patient's age and lack of known trauma make this diagnosis less likely, but it should still be considered.
Rare Diagnoses
- Gout or Pseudogout: Although less common in women, gout or pseudogout could cause acute ankle pain, especially if the patient has a history of joint problems or kidney disease.
- Osteoid Ostebone: A rare benign bone tumor that could cause ankle pain, especially if it occurs in the talus or other ankle bones.
- Erythema Infectiosum: A rare viral infection that can cause ankle pain and swelling, especially in children, but can also occur in adults.