Ankle/Foot pain DDx

Ankle and Foot pain – Differential Diagnosis

Common causes

• Soft tissue injury
  • Ankle sprain
  • Achilles tendonitis
  • Plantar fasciitis
• Corn/Callus/Verruca
• Osteoarthritis
• Ingrown toe nail
• Gout
• Metatarsalgia
• Lumbar radiculopathy

Must Not Miss

• Ankle /Foot fractures
• Ruptured Achilles tendon
• Acute ischaemia
• Septic arthritis
• Cellulitis
• Leg ulcers
• Diabetic foot (painless)
  • Ulceration
  • Charcot’s
  • Osteomyelitis

Easily missed

• Morton’s neuroma
• Painful polyneuropathy
  • Diabetes& Alcohol
• Rheumatoid arthritis
• Psoriatic arthropathy

Red flags

• Not weight-bearing
• Cold pulse-less leg
• Back pain & Loss of bladder or bowel control
• Hot/painful/swollen joint with little movement
• Sudden severe achilles pain with foot drop
• Ulceration/cellulitis
• Systemic symptoms (fever, weight loss)

Investigations to consider

• FBC, CRP/ ESR, serum glucose
• Auto-antibody screen, Rheumatoid factor
• Serum uric acid
• Local X-ray
• Blood culture
• MRI scan
• Nerve conduction studies
• Bone scan
• Angiography

Back to DDx