Discuss the differences in the various types of ankle pain.

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Discuss the differences in the various types of ankle pain. Include a description of the classification, treatment and differential diagnoses.

Students are expected to:

  1. Post an initial substantive response of to each questions as an FNP. Use Diagnostic Reasoning to answer each question.
  2. Please be sure to validate your opinions and ideas with in text citations and references in APA format.
  3. References and citations should conform to the APA 6th edition.
  4. Substantive comments add to the discussion and provide your fellow students with information that will enhance the learning environment.
  5. The peer postings should be at least one paragraph (approximately100 words)

Jason’s Response:

Discuss the differences in the various types of ankle pain. Include a description of the classification, treatment and differential diagnoses.

The most common of all ankle injuries are sprains (Goolsby & Grubbs, 2011). Sprains are defined as stretching and

tearing of ligament(s) (Dunphy, Winland-Brown, Porter, & Thomas, 2015). The history of present illness is reported injury

followed by a sudden onset of pain. Ankle sprains are generally classified by the location and grade. The mechanism of injury

typically dictates the location of the sprain. There are three anatomical locations of sprains: lateral, medial, and high ankle

(syndesmotic) (Maughan, 2018). Lateral sprains account for the majority of these and are generally caused by forceful

inversion and plantar flexion (Goolsby & Grubbs, 2011). Grade I sprains are generally mild with stretching and microscopic

tears of the ligament. The patient typically ambulates with minimal pain. Grade II sprains involve an incomplete ligament tear

and have some edema, bruising, and moderate pain. Grade III sprains are complete tears of the ligament with severe pain,

swelling, and tenderness. Patients with grade III sprains typically are not able to bear any weight or ambulate (Maughan,

2018). Ottawa ankle rules are helpful in determining if diagnostic imaging is warranted (Goolsby & Grubbs, 2011). Treatment

consist of R.I.C.E. therapy and NSAIDS for the first several days. An orthopedic referral is suggested for patients with a grade

III sprain and patients are typically placed in a cast for 4-6 weeks (Dunphy et al., 2015). Other causes of ankle pain include

bursitis, Achilles tendonitis, gouty arthritis, tendon rupture, and posterior impingement syndrome.


Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2015). Primary care the art and science of advanced practice

nursing (4th ed.). [VitalSource ]. Retrieved from https://bookshelf.vitalsource.com/#/books/97803234…

Goolsby, M., & Grubbs, L. (2011). Advanced assessment: Interpreting findings and formulating differential diagoses (2nd ed.).

Philadelphia, PA: F.A. Davis Company.

Maughan, K. L. (2018). Ankle sprain. In P. Eiff & F. G. O’Connor (Eds.), Ankle sprain. Retrieved from https://www.uptodate.com/

April’s Response:

Traumatic Ankle Pain

Ankle pain can arise from a variety of causes, both traumatic and non-traumatic in nature. Soft tissue injuries, fractures, and breaks are common differential diagnoses for traumatic ankle injuries. Common soft tissue injuries include sprain, strains, contusions, tendinitis, and bursitis. Soft tissue ankle injuries can further be classified as either an acute injury or a chronic overuse injury. One of the most common soft tissue ankle injuries is a sprain. A sprain is defined as an overstretching or tearing of a ligament, and is often sustained during an inversion injury to the ankle (American Academy of Orthopedic Surgeons, 2018). Plain radiographic films of the foot and ankle are often adequate for differentiating between a soft-tissue injury and a bony injury. Immediate treatment of ankle injuries include rest, ice, compression, and elevation of the affected extremity. NSAIDs can be utilized for inflammation and pain control. Splinting, casting, and or surgery may be necessary in unstable ankle fractures or ligament rupture (Maughan, 2018).

Non-Traumatic Ankle Pain

Gout, osteoarthritis, rheumatoid arthritis, and lupus are common differentials for non-traumatic ankle. While these conditions are chronic in nature, acute flares of such conditions can lead to episodes of increased pain and swelling in the ankle joint. Treatment for each of these conditions differs. Osteoarthritis causes pain in the ankle and other joints due to the breakdown of cartilage over time, resulting in the bones rubbing against one another. Anti-inflammatory medications can be used to treat this chronic pain, however surgery if often indicated in severe cases. Gout can cause ankle pain due to the buildup of uric acid in the joint space and may be preceded by an acute injury or illness (Arthritis Foundation, 2018). Corticosteroids, NSAIDs, and colchicine are often prescribed in cases of acute gout, with long-term therapy consisting of urate-lowering drugs such as allopurinol (Qaseem, Harris, & Forciea, 2016). Treatments for rheumatoid arthritis and lupus are often aimed at decreasing inflammation and pain by slowing the progression of tissue damage in the joints. This is often achieved by using a combination of anti-inflammatories, corticosteroids, and other autoimmune medications (National Institutes of Health, 2018).


American Academy of Orthopedic Surgeons. (2018). Sprains, Strains and

Other Soft-Tissue Injuries. Retrieved from https://orthoinfo.aaos.org/en/diseases–conditions/sprains-strains-and-other-soft-tissue-injuries/

Arthritis Foundation. (2018). Arthritis and Disease that Affect the Ankle. Retrieved from https://www.arthritis.org/about-arthritis/where-it-hurts/ankle-pain/causes/ankle-diseases.php

Maughan, K. L. (2018, October 15). Ankle sprain. Retrieved from https://www.uptodate.com/contents/ankle-sprain

National Institutes of Health (2018, April 24). Autoimmune Diseases of Rheumatoid Arthritis and Lupus. Retrieved from https://www.nih.gov/research-training/accelerating-medicines-partnership-amp/autoimmune-diseases-rheumatoid-arthritis-lupus

Qaseem, A., Harris, R. P., & Forciea, M. A. (2016). Management of acute and recurrent gout: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 166, 58-68.

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