Ankle Pain in Seniors: Causes and Treatment Options

Elderly individuals often experience ankle pain?

Hello, doctor.
Thank you for taking the time to answer my questions.
My mother, who is in her 70s and has a history of hypertension, started experiencing pain on the outer side of her left little toe about a week ago (without any sprain or impact).
She initially ignored it and continued her usual activities, but as the pain worsened, she applied pain relief patches.
It wasn't until yesterday that she informed the family about her foot pain, but this morning she found that her ankle also started to hurt significantly, making it difficult for her to walk without limping.

At the end of the previous year, she had a stress fracture in the metatarsal of her right foot due to a fall, and she had to rely on her left foot for several months.
I wonder if this could have contributed to her current condition.
Since that fracture, she has frequently experienced pain in her left foot (specifically the ankle), which has never been injured.
Recently, during a health check-up, it was found that her uric acid level is elevated (7.9), so whenever she experiences foot pain, doctors initially suspect gout.
However, her diet is quite light, and the pain does not seem to follow the typical progressive pattern of gout (where pain starts gradually, remains for several days to a week, and improves with rest).

I would like to ask the doctor if I should consider the possibility of gout in this situation.
Should I take my mother to see an orthopedic specialist or a rehabilitation specialist? I apologize for my limited medical knowledge and appreciate your help.

Liu Xiaojie, 40~49 year old female. Ask Date: 2023/12/11

Dr. Shen Boquan reply Orthopedics

Hello, if you suspect a bone injury, you can consult an orthopedic doctor for an examination.
During the period of right foot fracture, the left foot may bear more weight, which could lead to poor posture or inflammation of the tendons.
Hyperuricemia does not necessarily cause gout, but prolonged hyperuricemia can potentially damage the kidneys, so it is important to manage it.
If you are looking for rehabilitation treatment, please consult a rehabilitation specialist.
Wishing you good health, Shen Baiquan.

Reply Date: 2023/12/11

More Info

Understanding ankle pain in seniors, particularly in your mother's case, involves considering a variety of potential causes and treatment options. Given her age, medical history, and recent symptoms, it's essential to approach this issue holistically.

Possible Causes of Ankle Pain
1. Osteoarthritis: This is a common condition in older adults, characterized by the degeneration of joint cartilage and underlying bone. It can lead to pain, stiffness, and swelling in the joints, including the ankle. Given your mother's age, this could be a significant factor.

2. Gout: With her elevated uric acid levels (7.9), gout is a possibility. However, as you mentioned, the pain pattern does not align perfectly with typical gout attacks, which are usually sudden and severe. Gout typically affects the big toe but can also impact other joints, including the ankle.

3. Previous Injury: The history of her right foot's metatarsal fracture could contribute to compensatory mechanisms that lead to pain in the left foot. If she has been favoring her left foot due to discomfort or instability in the right, this could lead to overuse injuries or strain in the left ankle.

4. Tendonitis or Bursitis: Inflammation of the tendons or bursae around the ankle can cause pain, especially if there has been an increase in activity or strain on the joint.

5. Peripheral Neuropathy: Conditions like diabetes or hypertension can lead to nerve damage, which may cause pain or discomfort in the extremities.

6. Circulatory Issues: Given her history of hypertension, it's also important to consider vascular health. Poor circulation can lead to pain in the legs and feet.

Recommended Actions
1. Medical Evaluation: Given the complexity of her symptoms, it would be prudent to have her evaluated by a healthcare professional. A visit to a rheumatologist might be beneficial to assess for gout or other inflammatory arthritic conditions, especially considering her elevated uric acid levels.

2. Imaging Studies: An X-ray or MRI may be warranted to rule out any structural issues, such as fractures, arthritis, or other abnormalities in the ankle joint.

3. Orthopedic Consultation: If there are concerns about her previous injury affecting her current condition, a consultation with an orthopedic specialist could provide insights into any lingering effects from her past fracture.

4. Physical Therapy: If the pain is due to overuse or weakness, a referral to a physical therapist could help. They can design a rehabilitation program that focuses on strengthening the ankle and improving mobility.

5. Pain Management: Over-the-counter pain relievers such as NSAIDs (e.g., ibuprofen) may help alleviate her pain, but it's essential to consult with her physician before starting any new medication, especially considering her age and medical history.

6. Lifestyle Modifications: Encourage her to engage in low-impact activities that do not exacerbate her pain, such as swimming or cycling. Weight management and a balanced diet can also help manage her uric acid levels and overall joint health.

Conclusion
In summary, while gout is a potential consideration given her elevated uric acid levels, the gradual onset of pain and her previous injury history suggest that a multifaceted approach is necessary. It would be wise to consult with a rheumatologist or orthopedic specialist to obtain a comprehensive evaluation and appropriate imaging studies. This will help in determining the exact cause of her ankle pain and guide effective treatment options. Regular follow-ups and monitoring of her condition will be crucial in managing her symptoms and improving her quality of life.

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