Brief Answer:
Ankle swelling with precipitous blistered skin

Detailed Answer:
Thank you for your question and I'm very sorry this happened to you.

I'm not sure how you went to an orthopedic surgeon FIRST to x-ray the foot as opposed to primary care to examine the ANKLE. I wouldn't expect a foot x-ray to reveal anything significant about a focal ankle inflammatory process.

But at any rate whenever a clinical picture such as you describe occurs my first response is to rule out an infectious process which sounds to be CELLULITIC. This means that it involves soft tissues. Such an infection would not be expected to show up on an x-ray even if advanced whether foot or ankle.

At the same time of examining the patient's ankle I would send them for blood work which specifically assesses what to me appears to be a very real possibility of an infectious source. There should be a CBC with a differential, electrolytes, liver and renal enzymes, and under the chance that this could be involving the joint as in a rheumatological process (notwithstanding the X-ray result) I would also obtain inflammatory markers such as an ESR, C-reactive protein, Rheumatoid Factor, and ANA panel. I would also get a serum URIC ACID though I have a very low degree of suspicion that there is a gouty process afoot but the differential can still include ACUTE GOUTY ARTHRITIS.

Even though your diabetic condition appears to be under control the simple fact of the matter is that being diabetic puts you at risk for contracting infections from relatively minor or insignificant injuries therefore, I don't think it's necessarily any XXXXXXX what the most likely root of the hot swollen skin is but I think it needs to be intervened on sooner rather than later.

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