The management of the acutely swollen ankle

摘要

Patients presenting with an acutely swollen ankle are common in both the military and civilian settings. Accurate diagnosis is vital, as there are various potentially serious causes. This article aims to review the common causes of an acutely swollen ankle, as well as the rarer causes, with their significant consequences. Introduction Patients present commonly in both military and civilian settings with acutely swollen ankles (1). Rapid assessment is important to assess the potential cause and hence determine the initial management (2). Whilst most cases will be self-limiting, some may need urgent treatment. This article will discuss a structured approach to ankle assessment, and potential management options based on these findings. In general terms, swollen ankles can be due to either traumatic or non-traumatic causes. In a military setting, the vast majority of these presentations are traumatic, due to the young patient population and the nature of training and deployments. This paper will, however, discuss the full range of causes of ankle swelling. Traumatic Injuries History History is arguably more important than examination of the ankle (2). It is important to ascertain a full history of the injury, as this can give significant indications as to its extent and nature. The mechanism of injury may give an indication of the degree of force that the ankle has been subjected to, and as such the risk of, and type of, damage that is likely to have occurred. Falls from a height, and high velocity direct impacts, are more likely to result in fractures; however, seemingly innocuous inversion and eversion injuries in osteoporotic bones can also be a significant cause of bony injury (3,4). In ankle injuries, the ability, or otherwise, to walk immediately after the injury and at the time of first assessment is important to determine, an ability to walk usually indicating a lower probability of fracture.