Ankle and Knee Pain: Symptoms and Recommended Tests

Ankle and knee heat and swelling issues?

Hello Doctor,
I have a few questions I would like to ask.
I was part of the track and field team in elementary and middle school, where I trained intensively in short-distance sprints (200 meters) and did exercises like weighted lunges and plyometric jumps.
However, I did not continue with track and field in high school or college.
During college, I commuted daily from Taipei to Hsinchu by bus (a round trip of 3 hours) for four years.

Starting in my sophomore year, I began to experience discomfort.
After sitting or standing for a long time, my ankles and knees would feel uncomfortable (about 30 minutes after being in that position).
They feel hot, swollen, and slightly numb.
There have been several occasions where after standing for about half a day, I noticed small capillaries appearing around my ankles, and sometimes red spots would appear along the path of these capillaries.
When I shower, my ankles and knees are more sensitive to hot and cold water compared to my thighs, calves, and feet.
Lying down alleviates the pain, but I still feel some discomfort.
The symptoms seem to be worse in the summer than in the winter.

Could you please advise me on what tests I should undergo? Thank you.

Jijang ruwu de xuesheng, 20~29 year old female. Ask Date: 2020/05/06

Dr. Wang Zhaomin reply Rehabilitation

Issues with the peripheral vascular system or peripheral nervous system may lead to related symptoms.
It is recommended to consult a cardiovascular surgeon, neurologist, or rehabilitation specialist for an accurate diagnosis.

Reply Date: 2020/05/06

More Info

Understanding ankle and knee pain can be complex, especially when considering the history of physical activity and the symptoms you are experiencing. Based on your description, it seems that you have a combination of symptoms that could be indicative of several underlying issues.
Firstly, your history of intense training in track and field, particularly with activities like sprinting and weight-bearing exercises, could have contributed to overuse injuries or chronic conditions. The symptoms you describe—discomfort in the ankle and knee after prolonged sitting or standing, feelings of heat and swelling, and sensitivity to temperature changes—are often associated with conditions such as tendonitis, bursitis, or even early signs of osteoarthritis.

Given your symptoms, it would be prudent to consider a few diagnostic tests. Here are some recommendations:
1. Physical Examination: A thorough physical examination by an orthopedic specialist is crucial. They will assess your range of motion, strength, and any swelling or tenderness in the affected areas. This examination can help identify any specific areas of concern.

2. Imaging Studies:
- X-rays: These can help rule out any bone abnormalities, fractures, or signs of arthritis.

- MRI: If soft tissue injuries are suspected (like ligament tears or cartilage damage), an MRI can provide detailed images of the knee and ankle structures.

- Ultrasound: This can be useful for assessing soft tissue conditions, such as tendonitis or bursitis.

3. Blood Tests: If there is a suspicion of inflammatory conditions (like rheumatoid arthritis or other autoimmune disorders), blood tests can be helpful. These tests may include markers for inflammation (such as ESR or CRP) and specific autoantibodies.

4. Vascular Assessment: Given your mention of microvascular changes and sensitivity to temperature, it might be worth considering a vascular assessment. This could include Doppler ultrasound to evaluate blood flow in the lower extremities.

5. Nerve Conduction Studies: If you are experiencing numbness or tingling (the "麻麻的" sensation), nerve conduction studies might be warranted to rule out any nerve entrapments or neuropathies.

In terms of management, while awaiting your appointments and tests, consider the following:
- Activity Modification: Reducing high-impact activities and incorporating low-impact exercises (like swimming or cycling) can help alleviate stress on your joints.

- Physical Therapy: Engaging in physical therapy can be beneficial. A physical therapist can provide exercises to strengthen the muscles around your knee and ankle, improve flexibility, and enhance overall function.

- Ice and Elevation: Applying ice to the affected areas after activity can help reduce swelling and discomfort. Elevating your legs can also assist in managing swelling.

- Footwear: Ensure that you are wearing supportive footwear, especially if you are on your feet for extended periods. Custom orthotics may also be beneficial if you have any foot alignment issues.

Lastly, it’s important to listen to your body. If symptoms persist or worsen, seeking medical attention promptly is essential. Early intervention can often prevent further complications and lead to a more effective treatment plan.

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