Investigating Persistent Bilateral Ankle Swelling
Keywords:Tibialis Posterior Nerve Enlargement, Polyarteritis Nodosa, Ankle Swelling of Rare Causes
This paper presents a case-report of a young female reportingÂ sudden onset ankle swelling and pain, subcutaneous inflmmationÂ and progressive bilateral pes planus, in the context of no associatedÂ co-morbidities or risk factors for autoimmune and infective conditions. We discussed the appropriate imaging techniques which facilitated the diagnosis, which included Xrays, ultrasound and MRIÂ scans used to rule out soft tissue injuries, stress fractures, inflmmatory arthritis, and other causes of peripheral nerve entrapmentÂ and tendon pathology. The patient was diagnosed with polyarteritisÂ nodosa based on deep skin biopsy. This is the fist case ever reportedÂ showing signifiant peripheral nerve enlargement in the context ofÂ small vessel vasculitis.Â The imaging step-up approach is discussed in relation to the sensitivity and specifiity of different imaging techniques for assessingÂ joint, bone, tendon, ligament and nerve-related pathology. The rarity of this diagnosis in the context of a very common presentationÂ emphasised the need for specialist referral and has signifiant educational value.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under aÂ Creative Commons Attribution LicenseÂ that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (SeeÂ The Effect of Open AccessÂ and Benefits of Publishing Open Access).