Persistent Ankle Swelling and Pain: Seeking the Right Specialist - Family Medicine

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Hello! Thank you for reaching out with your concerns about your mother-in-law's persistent ankle swelling and pain. It sounds like she has been through quite a journey with her symptoms, and I understand how frustrating it can be when treatments do not yield the expected results.
From what you've described, your mother-in-law has already seen a rehabilitation specialist who diagnosed her with soft tissue tendonitis and has undergone physical therapy for two months without significant improvement. Additionally, she has tried acupuncture with some relief in pain but still experiences swelling. The traditional martial arts center suggested a mild sprain, which adds another layer of complexity to her condition.

Given that her symptoms have persisted for over six months, it may be time to consider a more comprehensive evaluation. Here are some potential next steps:
1. Orthopedic Specialist: An orthopedic doctor specializes in musculoskeletal issues, including bones, joints, ligaments, tendons, and muscles. They can perform a thorough examination and may recommend imaging studies such as X-rays or MRI to assess for any underlying structural issues, such as tears in the ligaments or tendons, arthritis, or other conditions that may not be apparent through physical examination alone.

2. Rheumatologist: If there is a suspicion of an inflammatory or autoimmune condition (such as rheumatoid arthritis or gout), a rheumatologist may be the appropriate specialist to consult. They can conduct blood tests and other evaluations to determine if there is an underlying systemic issue contributing to her symptoms.

3. Podiatrist: A podiatrist specializes in foot and ankle conditions. They can provide targeted treatment options and may offer different perspectives on managing her symptoms, including orthotics or specialized footwear.

4. Physical Medicine and Rehabilitation (PM&R): If she has not seen a PM&R specialist yet, this could be beneficial. They focus on restoring function and may offer alternative rehabilitation strategies that could be more effective.

5. Pain Management Specialist: If pain continues to be a significant issue, a pain management specialist can provide options for managing chronic pain, including medications, injections, or other interventions.

6. Considerations for Imaging: If not already done, imaging studies such as an MRI or ultrasound can provide valuable information about soft tissue structures, including tendons and ligaments, and help rule out conditions like tendon tears or other injuries that may not be visible on X-rays.

7. Lifestyle and Home Remedies: In the meantime, encourage her to continue with gentle range-of-motion exercises, elevation of the ankle, and the use of ice to manage swelling. Compression wraps may also help reduce swelling, but they should be used cautiously to avoid restricting blood flow.

It's essential to approach this situation holistically, considering both the physical and emotional aspects of chronic pain and swelling. Encourage your mother-in-law to communicate openly with her healthcare providers about her symptoms, treatment responses, and any concerns she may have.

In summary, given the duration and persistence of her symptoms, I recommend seeking an orthopedic specialist for a comprehensive evaluation. They can help determine the underlying cause of her ankle swelling and pain and guide her toward the most appropriate treatment options. I hope this information helps, and I wish your mother-in-law a speedy recovery!