From the Guidelines
Given the normal X-ray results, if pain persists, it is crucial to repeat the X-ray in 10 days to rule out any fractures that may not be immediately visible, such as stress fractures. The X-rays of your left ankle and foot show no fractures, which is good news. The ankle joint spaces are normal, indicating proper alignment between the bones. Two small, normal anatomical variants were noted: a tiny os trigonum (a small extra bone behind the ankle) and an os perineum (a small accessory bone in the foot). These are common findings and typically not the cause of pain. According to the American College of Radiology Appropriateness Criteria for chronic ankle pain 1, radiography should be considered the initial imaging study, as it can reveal various conditions such as osteoarthritis, calcified or ossified intra-articular bodies, osteochondral abnormalities, stress fractures, or evidence of prior trauma. Some key points to consider include:
- Radiography can identify ankle effusions with 53% to 74% accuracy, which are often associated with ligamentous injury or fracture 1.
- The presence of ossific fragments can indicate ligamentous injury or retinaculum avulsion, whereas periostitis can occur adjacent to tenosynovitis 1.
- In the meantime, managing pain with rest, ice, compression, and elevation (RICE protocol), along with over-the-counter pain relievers like acetaminophen or ibuprofen as needed, can be beneficial. If your pain worsens significantly before the 10-day mark, it is essential to contact your healthcare provider for further evaluation.
From the Research
X-ray Results and Pain Management
- The left ankle x-ray shows no fracture, and the ankle joint spaces are maintained, with a tiny os trigonum.
- The left foot x-ray also shows no fracture, with maintained joint spaces and an os perineum.
- If pain persists, a repeat x-ray is recommended in 10 days.
Pain Management Options
- According to a study published in 2018 2, paracetamol and ibuprofen are commonly used analgesics for treating pain after soft tissue injuries, but there is no significant difference in pain score between the two.
- A 2015 study 3 found that ibuprofen is consistently superior to paracetamol at conventional doses in a range of painful conditions.
- Another study from 2010 4 found that the concomitant use of ibuprofen and paracetamol does not modify the risk of major clinical safety outcomes compared to using either drug alone.
- A 2023 study 5 suggests that a combination of paracetamol and ibuprofen may be a useful option for managing acute mild-to-moderate pain in children, with a better analgesic power than monotherapy without compromising safety.
Diagnostic Imaging
- A 2019 study 6 found that physical therapists demonstrated appropriate use of diagnostic imaging in the vast majority of cases (91%), with judicious use of imaging and no issues with reimbursement.