Welcome to Orthosports Question for Physiotherapists April 2025. This month Dr John Negrine discusses a swollen ankle.
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QUESTION | A patient arrives with a swollen ankle and is asking what is this swelling on my foot and ankle?
A 57 year old man presents with swelling of the ankle. The swelling has been present for 2 years, is increasing in size and is not painful.
He plays tennis three times a week and skis but has no recollection of a major injury. He finds shoe wear increasingly difficult.
At surgery he has a lobulated white tumour not invading the deep tissues or bone. Pathology: Desmoplastic fibroblastoma – benign.
The commonest swelling or tumour in the foot and ankle is a ganglion. Fluid filled and emanating from either a joint or a tendon sheath. Most patients do not give a history of trauma. They are usually painless unless impinging on a nerve, in the tarsal tunnel they can cause pain and numbness on the sole of the foot. When large they can cause difficulty with shoewear.
They can be left alone if proven to be a ganglion. Aspiration is worthwhile diagnostically but has a low cure rate, I quote less than 10%. Surgery is accompanied by a recurrence rate of 25%. MRI is useful to accurately determine the origin and attempt to shut off the neck.
Solid tumours in the foot and ankle are still most likely benign but life is as they say is “full of surprises”! The commonest benign solid tumours include fibromas, giant cell tumours of the tendon sheath, schwannoma (nerve sheath tumour) and the terrifyingly named but quite benign “angioleiomyoma.”
Malignant tumours are rare but don’t forget malignant melanoma is often seen in the foot and ankle. Other solid tumours are synovial sarcoma and rhabdomyosarcoma. They are optimally treated by a specialist bone and soft tissue tumour centre such as the Royal Prince Alfred in Sydney where they have tumour specialist radiologists, pathologists and surgeons.