A 70-year-old woman presents with pain and swelling in her ankle. She says she twisted her ankle on a curb a few days ago. She has a history of rheumatoid arthritis and is on corticosteroids. On examination, her ankle is swollen and tender over the distal fibula. She is unable to bear weight. What should be the concern and the next steps?
In a patient with a history of rheumatoid arthritis and corticosteroid use who presents with pain and swelling in the ankle after a minor trauma, a suspicion of an insufficiency fracture should be raised. Corticosteroids can lead to osteoporosis and increase the risk of fractures. An X-ray of the ankle should be obtained to look for any fractures. If the X-ray is inconclusive and suspicion remains high, further imaging such as an MRI or bone scan could be considered.