Differential Diagnosis for Right Ankle Pain
Single Most Likely Diagnosis
- Ankle Sprain: The mechanism of injury, with significant weight placed on the right leg to prevent a fall, and the location of the pain on the bone where the anterior talofibular ligament is situated, are highly suggestive of an ankle sprain. The delayed onset of pain, initial widespread pain that localized, and the ability to bear weight and move the foot also support this diagnosis.
Other Likely Diagnoses
- Peroneal Tendinopathy: The pain location and the fact that the pain worsened over time could suggest peroneal tendinopathy, especially if the peroneal tendons were stressed during the maneuver to prevent the fall.
- Ankle Contusion: Although there's minimal swelling and no significant bruising, an ankle contusion could still be considered, given the mechanism of injury and the initial widespread pain.
- Stress Fracture: The delayed onset of pain and the fact that the pain persisted despite initial relief with Aleve could raise the possibility of a stress fracture, particularly if the patient has a history of repetitive stress or osteoporosis.
Do Not Miss Diagnoses
- Osteochondral Lesion of the Talus: This condition, which involves a fragment of cartilage and bone becoming detached, can occur after an ankle injury and may not be immediately apparent. It's crucial to consider this diagnosis due to its potential for long-term consequences if left untreated.
- Compartment Syndrome: Although less likely given the patient's ability to move the foot and the absence of severe pain or pallor, compartment syndrome is a medical emergency that requires prompt recognition and treatment.
- Deep Vein Thrombosis (DVT): The worsening of swelling overnight could suggest a DVT, especially if the patient has risk factors such as immobility or a history of clotting disorders.
Rare Diagnoses
- Ganglion Cyst: A ganglion cyst could cause localized pain and swelling, but it would be an unusual cause of acute ankle pain following a traumatic event.
- Infectious or Inflammatory Arthritis: Conditions like septic arthritis or rheumatoid arthritis could cause ankle pain and swelling, but they would typically be accompanied by other systemic symptoms or a history of similar conditions.