Recurring Ankle Swelling: Possible Causes and Solutions - Internal Medicine

Repeated mild swelling and subsiding of the ankle in a short period of time?

---

Hello, Doctor.
Let me summarize my condition.
On the evening of October 18, I experienced pain in the left heel while walking, and my ankle was slightly swollen that night.
On October 19, I felt a sharp pain on the inner side of my left ankle, and there was mild swelling on the outer side.
I visited a traditional Chinese medicine practitioner for acupuncture around 9 PM.
On the morning of October 20, my left ankle, foot, and toes were all swollen and extremely painful, making it impossible to move or walk in any direction.
Throughout the day, I felt warmth in my foot, and there was a small red area near the inner side of my ankle.
Over the next few days, the swelling gradually decreased, and the range of motion in my ankle improved.

On October 26, my left ankle was still slightly swollen, so I visited a rehabilitation clinic.
The doctor informed me that there was fluid accumulation in my ankle and that I had not twisted it.
The only activity I had done in the cold weather a few days prior was some toe raises, so I was advised to see a rheumatologist for further evaluation.
On October 27, I had blood tests at the rheumatology clinic.
On November 3 and 4, I occasionally felt a dull ache in my ankle.
On November 5, after the afternoon, I experienced sharp pain while walking, mostly on the lower inner edge of my ankle.
Around 8 PM, I noticed mild swelling starting in my left ankle (outer side and right front side), and later that night, I also felt sharp pain in my left big toe.

On November 6, during my follow-up at the rheumatology clinic, the doctor informed me that all test results were normal (tests included ESR, hsCRP, SGPT (ALT), Creatinine, GFR, Uric Acid, ANA, RA) and prescribed anti-inflammatory pain medication.
On November 7, my left ankle was slightly swollen, with sharp pain on the inner lower edge of the ankle.
At times, I felt discomfort extending to my calf (similar to soreness), and I felt like I had one leg shorter than the other while walking.
On November 8, I visited another rehabilitation clinic, where the doctor noted that there was still some fluid accumulation and advised that the medication would help reduce it.
That night, I began taking "Ketoprofen" tablets.
Before bed, my left foot, including the toes, was slightly swollen, and for the first time, I noticed mild swelling in the front inner side of my right ankle.

On November 9, I woke up with reduced swelling in my left foot, while the front inner side of my right ankle remained slightly swollen.
I took "Ketoprofen" tablets with all three meals.
Before bed, I noticed slight swelling on the right front side of my left ankle, but my toes were not swollen, and my right foot was also slightly swollen with mild soreness.
On November 10, both feet showed no swelling from morning until bedtime, and I continued taking "Ketoprofen" tablets with all meals.
On November 11, I woke up with no swelling, but my left ankle's right front side was slightly swollen in the evening, and I only took "Ketoprofen" tablets for breakfast and dinner.
On November 12, there was no significant swelling from morning to bedtime, with only slight swelling on the right front side of my left ankle, some soreness in my calf, and mild discomfort in my heel.
My right foot showed no symptoms, and I only took "Ketoprofen" tablets for breakfast.

On November 13, I woke up with no swelling, but after standing for a longer period, I felt discomfort in my heel.
Before bed, I compared both legs and noticed that the lower half of my left calf felt relatively swollen compared to the right.
From November 14 to November 23, I woke up with no swelling, but after showering or before bed, I noticed slight swelling on the right front side of my left ankle.
On November 24, I woke up with slight swelling on the right front side of my left ankle.
From November 25 to 26, I woke up normally, but before bed, my left ankle's right front side was slightly swollen.
On November 27, I woke up with no swelling, but in the afternoon, I noticed slight swelling on the right front side of my left ankle.
Around 8 PM, after spending about an hour indoors (with cold hands and feet), I started to feel sharp pain on the inner side of my left ankle while walking.
After about 20 minutes of warming up, the pain subsided, but around 11 PM, my foot started to feel cold again, and I experienced sharp pain on the inner side of my ankle a few times, along with mild swelling.

On November 28, my left ankle's right front side was slightly swollen all day, and in the evening, I felt mild soreness in my calf and ankle.
On November 29, I woke up with noticeable reduction in swelling, but in the afternoon, my left ankle's right front side was slightly swollen again.
After the doctor suspected gout due to the swelling earlier this year, I have been drinking 2000 to 3000 ml of water daily and maintaining a light diet while avoiding high-purine foods.
I have to stand for long periods at work, and I have the following questions for you:
1.
Is it possible that the sudden swelling on October 20 was caused by the acupuncture I had the previous night?
2.
Recently, I have also felt sharp pain on the inner side of my left ankle after experiencing cold hands and feet.
Is this related to gout or other diseases?
3.
In the 3 to 6 months prior to the swelling in my ankle, I had uncertain conditions that might have been either tinea or eczema—one itchy spot on the back of my arm and two non-itchy spots on the inner thighs and calves, each about the size of a five-dollar coin.
Could this be related to my ankle issues?
4.
My symptoms have persisted for over a month, with recurring mild swelling and reduction on the right front side of my left ankle.
Does gout also present with such intermittent swelling and reduction?
Could you please provide me with some advice? If there is a high likelihood of gout, how can I improve my current symptoms? If not, could you suggest other directions for further investigation of my symptoms or medical consultation? If you need any additional information for reference, please let me know.
Thank you!

---

Miss Lin, 30~39 year old female. Ask Date: 2023/11/29