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     ANKLE PAIN – Assessment of the Musculoskeletal System    

    CASE STUDY -ANKLE PAIN – Wk8 – Assessment of the Musculoskeletal System
    A 46-year-old female reports pain in both of her ankles, but she is more concerned about her right ankle. She was playing soccer over the weekend and heard a “pop.” She is able to bear weight, but it is uncomfortable. In determining the cause of the ankle pain, based on your knowledge of anatomy, what foot structures are likely involved?
    Assignment instructions:
    With regard to the case study below,
    • Consider what history would be necessary to collect from the patient in the case study you were assigned.
    • Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition.
    • How would the results be used to make a diagnosis?
    • Identify at least five possible conditions that may be considered in a differential diagnosis for the patient. and justify why you selected each
    • Out of the five differential diagnoses you identify, determine which of the conditions you would reject and why. Identify the most likely condition, and justify your reasoning.
    • What special maneuvers will you perform? Should you apply the Ottawa ankle rules to determine if you need additional testing?



Subject Nursing Pages 7 Style APA


Assessment of the Musculoskeletal System: A case of Patient with ANKLE PAIN

Patient’s History and Examinations

From the scenario under consideration, the patient complains of bilateral ankle pain that she developed when playing soccer over the weekend when she heard a “pop.” While she is capable of bearing her weight, she has a lot of discomfort doing that.

For purposes of gathering more information about the patient’s condition, various examinations and diagnostic tests will be necessary. Physical examinations will include height, vital signs, pulse rate, temperature, respiratory rate, non-laboured, and oxygen saturation. Subjective data that would be instrumental are reason for complaint (which for this case is ankle pain), medications currently taking, allergies, past medical history, past surgical history, reproductive/sexual history, social/personal history, immunization history, lifestyle, and family history. Additional questions that would help gather more information include: How do you rate your pain on a 0-10 scale (10 being the worst degree you have ever felt); Is there anything that alleviates the pain? Have you ever had pain in any or both of your ankles?; Have you a history of bone injuries or fractures?

Apart from the subjective examinations and diagnostic tests, I would also gather objective data, like review of systems, review general information (like about fatigue and fever and difficulty in bearing the weight), HEENT, neck, breasts, respiratory, peripheral vascular/cardiovascular, gastrointestinal, genitourinary, musculoskeletal (like bilateral ankle pain with ankle discomfort on the right ankle on ambulation), psychiatric, neurological (like oriented and alert place about time, place, person, and event), skin, hematologic, endocrine, immunologic/allergic diagnostic tests.

Results Be Used To Make a Diagnosis

The results of the examinations and diagnostic tests would be employed variedly to help make informed decisions regarding the patient. The table below will summarize how that the results would help in the diagnosis.

Exam and Diagnostic Tests


Use in diagnosis


A&O x 4


–          Means that the patient is alert and oriented to situation, place, time, and person


–          Cooperative and pleasant

–          The patient is not in an acute distress


–          Atraumatic and normocephalic

–          No conjunctival erythema

–          Sclera anicteric



–          No lesions

–          Oropharynx red

–          Moist mucous tissues


–          Trachea midline

–          No JVD

–          Supple

–          The patient has no swelling, pain, or palpable nodules


–          Clear to bilaterally auscultation

–          The patient has no accessory muscle employment

Peripheral vascular/Heart

–          Swelling of the patient’s right ankle

–          Rhythm and regular rate noted

–          The patient has no palpitation and murmurs

–          The patient has normal capillary replenishment or has no cyanosis or clubbing

–          The patient has two-pronged equal pedal pulses


–          Non-tender, non-distended, and soft

–          No rebound, rigidity, or guarding

–          No palpable Hepatosplenomegaly


–          Lower extremities with reports about pain

–          Right ankle swelling

Differential Diagnoses

There are several possible conditions that the patient may be considered for during a differential diagnosis. Below are the few possibilities.

  1. Plantar fasciitis: This condition affects women as twice as often as men, which is the result of chronic weight-bearing strain and stress when permissiveness of foot structures allow one’s talus to slide medially and forward, plantar ligaments, and calcaneus to fall and face pack to stretch (Karpov et al., 2019). Such pain gets worse on awakening and may be relieved with non-weight bearing activities that usually involve one’s heel (Kemler et al., 2015).
  2. Grade Two Lateral Ankle Sprain: Hunt et al. (2017) explain that sports injuries happen when cutting, landing, running, or from direct contact which can sometimes generate “pop” sounds or audible tear along with swelling that are immediate. Lievers and Adamic (2015) explain that during such impacts, ecchymosis may lag behind by a day or so. An ankle sprain injury is an injury in at least one ligament in one’s ankle with symptoms, like swelling, pain, soreness, difficulty walking, bruising, and joint stiffness (Skazalski et al., 2018). Based upon the reported symptoms along with physical assessment results, ankle sprain becomes the patient’s primary diagnosis. Anteroposterior lateral X-Ray views possibly during inversion or with weight-bearing will tell the degree of ligament injury.
  3. Ankle Fracture: Ankle may involve at least one ankle bone, like talus, fibula, and tibia with symptoms, like swelling, tenderness, immediate pain, deformity, bruising, and incapability to bear weight (Sánchez-González et al., 2019).
  4. Achilles tendon hurt: Usual manifestation is pain after a sudden snap a person’s lower calf with the incapability of standing on feet of the affected leg/side (Ardahan & Simsek, 2016). Aktürk et al. (2019) add that Achilles tendinitis infection, generating swelling and pain symptoms where the tendon adds into the calcaneous, and patient may report feeling tightness that make their running and walking hard.
  5. Anterior impingement: Also known as footballer’s ankle, presents with symptoms, like inflammation and pain, including a fall in overall ankle motion range, largely affecting dorsiflexion (Pelletier et al., 2015).
  6. Navicular fracture: Manifests as slowly increasing naviscular pain in people to the dorsum of their foot, sometimes along a person’s arch, and worsening when the person gets involved in physical activities (Karpov et al., 2019).
  7. Post-exercise muscle tenderness: manifests as a pain or discomfort to the distal section of one’s skeletal muscle after participating in physical activities that one is not formerly used to, and decreased flexibility and strength (Skazalski et al., 2018).

From the possible diagnoses listed above and the symptoms presented by the patient, the patient did suffer an ankle sprain. For that reason, I would suggest the RICE treatment (rest, ice, compression, and elevation), along with follow-up during the first few weeks (Ardahan & Simsek, 2016).

Maneuvers That I Would Perform On the Patient

There are various maneuvers that I will perform on the patient. Having diagnosed the patient with ankle sprain, the foot structures possibly involved are likely to be the lateral ankle complex, an area that is most susceptible to commonplace “roll” or inversion-kind twist, despite the fact that fibula, talus, and distal bones ought equally to be taken into consideration owing to the fact that they the principal make-ups of a person’s ankle joint (Hunt et al., 2017). To better attend to the patient, I would carry out a palpation and visual assessment of her bilateral lower extremities to determine whether there are any abnormalities, and evaluate distal neurovascular status of her motor, sensory abilities, and pulses. Through the visual observation, I will be able to note any signs of pain exacerbations and any particular range of motion (ROM). Similarly, I would carry out a Talar Tilt Test to help assess the integrity of the patient’s lateral ligaments, her anterior draw test with the aim of assessing her anterior talofibular ligament, her external rotation test with the goal of assessing her syndesmosis, Thompson’s test with the goal of assessing her heel cord, the compression test with the goal of assessing the patient’s distal tibiofibular joint, and fibula and tibia integrity assessment (Sánchez-González et al., 2019). Moreover, I would employ the Ottawa ankle rule to guide radiologic diagnostics based on the physical examination, along with X-Ray imaging should the patient be complaining of pain in her malleolar area, and either show tenderness either to medial or lateral malleolus, or incapability of ambulating (Aktürk et al., 2019). 



Aktürk, S., Büyükavcı, R. & Aktürk, Ü. (2019). Relationship between musculoskeletal disorders and physical inactivity in adolescents. J Public Health (Berl.) 27, 49–56. https://doi.org/10.1007/s10389-018-0923-7

Ardahan, M., & Simsek, H. (2016). Analyzing musculoskeletal system discomforts and risk factors in computer-using office workers. Pakistan journal of medical sciences32(6), 1425–1429. https://doi.org/10.12669/pjms.326.11436

Hunt, K. J., Hurwit, D., Robell, K., Gatewood, C., Botser, I. B., & Matheson, G. (2017). Incidence and Epidemiology of Foot and Ankle Injuries in Elite Collegiate Athletes. The American Journal of Sports Medicine, 45(2), 426–433. https://doi.org/10.1177/0363546516666815

Karpov, V.Y., Zavalishina, S., Dorontsev, A., Skorosov, K.K., & Ivanov, D.A. (2019). Physiological Basis of Physical Rehabilitation of Athletes after Ankle Injuries. Indian Journal of Public Health Research and Development, 10, 2051. DOI:10.5958/0976-5506.2019.03151.6

Kemler, E., van de Port, I., Valkenberg, H., Hoes, A. W., & Backx, F. J. (2015). Ankle injuries in the Netherlands: Trends over 10-25 years. Scandinavian journal of medicine & science in sports25(3), 331–337. https://doi.org/10.1111/sms.12248

Lievers, W. B., & Adamic, P. F. (2015). Incidence and Severity of Foot and Ankle Injuries in Men’s Collegiate American Football. Orthopaedic Journal of Sports Medicine. https://doi.org/10.1177/2325967115581593





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