Right, I'm gonna need to make this as short as I can because if I go on forever it will surely be the next war in peace.
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I have been seeing a 43 year old lady in clinic recently who attended complaining of lateral ankle pain on the left foot localised to the medial malleolus. It is worse after long periods of rest and particularly getting up in the morning. She remarks that it is incredibly painful to touch and that if she knocks it on anything it will amke her burst out in tears from the agony. She also reports 'it is like the pain is in the middle of my ankle joint and eminating out' She did slip and fall off the stairs 4 years ago which caused the ankle to swell and eccymosis to develop but she never sort medical care as she was on her way to the airport for 4 weeks in the carribean :bang:. She is highly pronated.
Well at my initial appointment with her I sent her straight for an x-ray and blood work (dunno why the blood work but she was showing some signs of systemic RhA symptoms) which all came back negetive. No break, fracture or arthritis and blood work clear. Hmmmm she says.
So we went down the route of arch supports to correct her pronation and advised that she see a GP for pain relief medication. Our initial thoughts here were soft tissue injury, come back and see us in 2 months we say...
2 months she return ' the pain is better but not completely gone, I hit it on a desk at work and it was agony I could blearly walk home' at this point the patient crys because she thinks that she is going to have to have a her foot off to solve this :craig:
So we have tried ultrasound around the area assuming that it is soft tissue as a trail and her to review her tomorrow.
Reason that I am asking is I was just looking through her file and though that it was best to ask the masters WHAT CAN CAUSE A MEDIAL MALLEOLUS TO HAVE SCREAMING AGONY ON PALPATION AND KNOCKING IF NOT A FRACTURE OR ARTHIRITIS?
Any help much appreciated and if you need any more info please let me know
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