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A 63-year-old man comes to clinic with a 2-hour history of ankle pain after stepping off the curb and twisting his ankle.

  • What other aspects of the history will be helpful in determining the etiology of his ankle pain?

Ankle pain accounts for 20% of musculoskeletal complaints in outpatients.1 Etiologies of foot and ankle pain include trauma, inflammatory arthritis, sprains, shoe problems, and local manifestations of systemic diseases. The history is critical for determining which diagnoses to consider.

Foot problems are rare among populations that do not wear shoes. Females are 9 times more likely than men to have foot problems. Chronic foot pain (lasting > 2 weeks) is more common than acute foot pain (lasting < 2 weeks).2

Between 5 and 10 million ankle injuries occur in the United States each year. Of these injuries, 85% are sprains. Adult age 21 to 30 years old are at greatest risk.

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AnkleJoint created by the calcaneus, talus, tibia, and fibula.
ArthritisInflammation of the joint characterized by swelling, warmth, redness, pain, and restriction of motion.
BunionBony prominence and abnormal angle of the great toe and first metatarsophalangeal (MTP) joint.
CallusA hard thick area of skin occurring in parts of the body subject to pressure or friction.5
CornAn area of hard or thickened skin on or between the toes.5
Deltoid ligamentA triangular-shaped ligament found on the medial side of the ankle, connecting the tibia to the navicular, calcaneus, and talus.
EversionTurning outward of the ankle; the plantar aspect of the foot is directed medially.
ForefootIncludes toes and the distal aspect of metatarsals.
HindfootIncludes the entire heel.
InversionTurning inward of the ankle; the plantar aspect of the foot is directed laterally.
Lateral malleolusJoint created by fibula and talus.
Medial malleolusJoint created by tibia and talus.
MidfootArea between distal metatarsals and beginning of the calcaneus.
Pes cavusHigh arched foot.
Pes planusFlat foot.
PodagraGout affecting the first MTP.
PronationThe act of turning the foot outward so that the lateral margin of the foot is elevated.
SprainInjury to a ligament caused by sudden stretching.5
SupinationThe act of turning the foot inward so that the medial margin is elevated.5
Tarsal tunnelThe tunnel formed by the flexor retinaculum.

Foot Pain

In an Italian study of 459 individuals, 21.8% had foot pain with standing, and 9.6% had pain at rest. The most common physical findings included calluses/corns (64.8%), hypertrophic nails (29.6%), hallux deformities (21.2%), and absent arterial pulses (15.9%).3 The Women's Health and Aging Study reported that 32% of disabled women had moderate to severe foot pain; obesity and osteoarthritis of the hands and feet were more common in these women.4 Ultimately, determining the etiology of foot pain depends on the location ...

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