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| Painful Ankle | ||
| Robin R. Elliot, MA, MRCS, Mustafa I. Hafez, MB.BCh, MS(Orth), PhD, and Richard R.H. Coombs, FRCS, MA, MRCP, MCh, DM* Department of Orthopaedics, Charing Cross Hospital, London W6 8RS, United Kingdom. E-mail address for R.R. Elliot: rre72@yahoo.co.uk |
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| A twenty-four-year-old Kurdish man who had recently arrived in the United Kingdom and was seeking political asylum presented to our orthopaedic clinic with pain in the right ankle. He had previously endured "falaka" (a punishment involving beating of the soles of the feet) on a number of occasions while he had been a detainee in another country. The initial intense pain from these beatings had long subsided, but the patient continued to have discomfort and disability. | ||
| Physical examination revealed an antalgic gait and some restriction in both dorsiflexion and plantar flexion at the ankle but no gross deformity. There were no signs of infection. | ||
| Radiographs of the ankle showed a cystic lesion of the talus (Fig. 1). Magnetic resonance imaging confirmed the presence of a cystic lesion (Fig. 2) and a bone scan indicated a hot spot in the talar region (Fig. 3). | ||
 Fig. 1 |
Fig. 1 Plain radiograph of the ankle joint, showing a cystic lesion within the talus. For larger view, click on image |
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 Fig. 2 |
Fig. 2 A short tau inversion recovery (STIR) magnetic resonance image of the ankle, showing a fluid-filled cystic lesion within the talus. For larger view, click on image |
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 Fig. 3 |
Fig. 3 An isotope bone scan showing a hot spot in the talar region of the right ankle. For larger view, click on image |
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| What is the diagnosis? | ||
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