Evidenced-based clinical review: Laterally-based ankle and hindfoot pain

The diagnosis of laterally-based ankle and hindfoot pain is comprehensive and the possibilities of injury origin can be easily overlooked. Injury misdiagnosis can result in improper treatment and can lead to exacerbated injuries, persistent pain, and chronic problems. Successful diagnosis of laterally-based ankle and hindfoot injuries requires knowledge of the differential diagnosis. This differential can be classified into somatic dysfunction, fractures, ligamentous injuries, tendon injuries, osteochondral lesions, and nerve lesions. Narrowing the differential to arrive at an accurate diagnosis necessitates a detailed patient history, an understanding of the injury mechanism, the selective use of diagnostic imaging modalities, and a thorough clinical examination that incorporates palpation, range of motion (ROM), and provocative maneuvers. The initial treatment of minor lateral ligament and syndesmotic sprains should include protection, rest, ice, compression, and elevation (PRICE), weight bearing to tolerance, and pain control with non-steroidal anti-inflammatory drugs (NSAIDs). Early mobilization and functional rehabilitation including osteopathic manipulative therapies (OMT) should also be incorporated to reduce pain and swelling and improve range of motion. The initial treatment of fractures, ligament and tendon injuries, osteochondral lesions, and nerve injuries should include PRICE treatment with non-weight bearing and the referral to an orthopedic or sports medicine specialist should be considered.