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22-year-old woman with acute-on-chronic ankle pain

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A 22-year-old woman with a history of chronic right ankle pain for 8 years presented with pain exacerbation over the right talus over the previous 7 months. There was no recent history of trauma. The pain was aggravated by not wearing orthotics. No alleviating factors were identified. There was no history of instability or clicking. Past treatments included physiotherapy and ibuprofen.

Physical examination revealed pes planus with normal gait, normal weight bearing and normal range of motion. No skin changes or pain on palpation was identified. Focused neurovascular examination was normal. The anterior drawer, talar tilt and tibial torsion tests were all normal.

Ankle radiographs (figures 1 and 2) were obtained.

Figure 1

Anteroposterior radiograph of the right ankle.

Figure 2

Lateral radiograph of the right ankle.

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