21 Year Old Female With Ankle Pain

A 21 Year old comes to the clinic with ankle pain. Her vitals taken are:
Temp: 101 F
BP : 120/80 mmHg
HR: 80/min
R/R: 20/min
The patient tells that she twisted her right ankle one week ago. She scraped off a little skin and has a sudden popping sensation on the outside part of her right ankle. The pain is severe and sharp and moves into her right foot. The pain gets better when she elevates her leg and puts ice on the ankle. She has noticed increasing redness and swelling with some oozing over the last 3 days.

The picture of her ankle is shown below:

On palpation the right ankle and lateral malleolus is very tender with limited range of motion because of pain.

What is the differential diagnosis and how will you support your diagnosis on the basis of history and physical findings?


1. Cellulitis of ankle.

• abrasion one week ago
• increasing redness and swelling
• fever
• tender to touch

2. Sprain of ankle:

• Twisted ankle and heard a pop
• Decreased range of motion

3. Fracture of ankle:

• twisted ankle and felt a pop
• tenderness at lateral malleolus
• redness over the ankle

What tests will you advice that will help in Diagnosis?

1. X-Ray right ankle

2. Wound culture and sensitivity

3. Complete blood count

4. Blood culture and sensitivity