History to Elicit for Left Ankle Pain
Begin by determining the chronicity of pain: if symptoms have persisted >6 weeks, this constitutes chronic ankle pain requiring a different diagnostic pathway than acute injury. 1
Essential Historical Elements
Mechanism and Timing
- Determine if there was a specific traumatic event (fall, twist, direct blow) or if onset was insidious without clear injury 1
- Establish exact duration of symptoms: acute (<3 weeks), subacute (3 weeks to 6 months), or chronic (>6 weeks) 1
- Ask about the ability to bear weight immediately after onset and whether this has changed over time 1
Pain Characteristics
- Pinpoint the exact location of maximal tenderness: anterior, posterior, medial, lateral, or diffuse 2, 3
- Characterize pain quality: sharp, dull, aching, burning, or clicking 4, 5
- Identify aggravating factors: walking, running, specific movements, pressure from shoes, or rest pain 1, 6
- Determine relieving factors: rest, elevation, walking barefoot, or specific positions 1
Occupational and Activity History
- Document occupation and daily physical demands: standing, walking, lifting, or sedentary work 6
- Assess athletic activities and training intensity: running, jumping, weightlifting, or sports involving cutting movements 6, 7
- Ask about recent changes in activity level or new exercise regimens 6
Past Medical History
- Screen for diabetes mellitus and peripheral neuropathy, as these patients may have fractures without typical pain patterns 1
- Inquire about history of gout or inflammatory arthritis, particularly if bilateral ankle involvement 8
- Document previous ankle injuries or surgeries and their outcomes 5, 9
- Ask about vascular risk factors: smoking, hypertension, hyperlipidemia, claudication symptoms 1, 8
Associated Symptoms
- Assess for swelling, erythema, or warmth suggesting inflammatory or infectious processes 8, 3
- Ask about mechanical symptoms: locking, catching, giving way, or instability 5, 9
- Screen for neurologic symptoms: numbness, tingling, weakness, or radiating pain 1
- Inquire about systemic symptoms: fever, weight loss, or morning stiffness 8
Red Flags Requiring Urgent Evaluation
Immediately assess for these critical findings that necessitate urgent workup: 1, 4, 6
- Acute inability to bear weight
- Significant deformity or swelling
- Point tenderness over specific osseous structures (malleoli, talus, calcaneus)
- Neurovascular compromise (coldness, absent pulses, numbness in foot)
Common Pitfalls to Avoid
- Do not dismiss bilateral ankle pain as simply "overuse" without considering systemic causes like inflammatory arthritis or vascular disease 8
- Avoid assuming all ankle pain in diabetics is neuropathic; these patients can have occult fractures despite minimal symptoms 1
- Do not overlook posterior heel pain as simple Achilles tendonitis without considering insertional pathology, bursitis, or Haglund's deformity 1