This patient needs to be evaluated for possible fracture of the calcaneus. Some other diagnoses to consider are medial ankle sprain, loose bodies, plantar fasciitis, loss of medial and lateral arch support, mortise joint fixation, intersegmental dysfunction of the bones of the foot. Also, to be considered are late effects of chronic lateral ankle sprain including atrophy, fibrosis, and trigger points.

Physical Exam Findings:

This patient has pain and swelling in the medial ligaments of the ankle however they are solid and intact. There is pain and swelling in the plantar fascia medially and laterally. There are many fixations of the bones of the foot including metatarsals, cuneiforms, navicular, cuboid, talus, and calcaneus. The fibular and tibia are also misaligned whereas the medial malleolus is more posterior than that of the opposite side. There is atrophy in the lateral ankle of the peroneal, posterior tibialis and gastrocnemius muscles whereas the difference in circumference is ¾ of an inch less at the left ankle. This patient’s ankle is unstable when she is standing on one leg.

Question: What is your working diagnosis at this point?