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Have had intermittent ankle pain radiating to calf and in femur. What is it?

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Practicing since : 1999
Answered : 550 Questions
Dear Dr,

I have had an intermittent right ankle pain since late 2008 when I had it investigated and nothing was found. I now comes and goes only when I lie down. On the rare occasions when I get it during the day, standing up, it tends to radiate more into the calf area.

In addition, in the last few months, I have had a radiating pain also in the lower part of my left femur. Could all this be rheumatism or could it be more sinister (like some form of bone cancer). I am particularly concerned as I am about to have a prostate biopsy because I am almost certain of having PCa.

Looking forward to your answer.

Posted Sun, 1 Sep 2013 in Lupus
Answered by Dr. Divya Agarwal 2 days later
Brief Answer:
Probably osteoarthritis of ankle.

Detailed Answer:

This seems like an injury may be a minor one which you never noticed. It might have produced certain amount of damage because of which it never really cleared up. And on and off it gets triggered. It may be a case of secondary osteoarthritis.

It is less likely to be a sinister cause as it is too long for that to last. In case it was due to cancer other bone pains should have also started.

So the way to go about it is, to get an Xray of the area and if nothing substantial on that then an MRI of the ankle would be required to completely diagnose the problem.

Hope this helps. Let me know if you need clarification.

Above answer was peer-reviewed by
Follow-up: Have had intermittent ankle pain radiating to calf and in femur. What is it? 8 hours later
Yes, interesting new hypothesis, I will pursue this avenue of investigation.

My local GP in Oman where I live suggested it could be the onset of mild gout due to excess Uric Acid. Then I remember that ine day 6 months ago, I had an excruciating pain in my left foot which I think might have started in my big toe. Nothing since though and that was the only time in my life!

My UA level is just on the high side of the normal range so she just suggested that I avoid food XXXXXXX in UA which I have started doing. It wouldn't surprise me at all if I was getting the beginning of gout because my nutrition is very XXXXXXX and I drink close to the limit of 21 units of alcohol a week. I will reduce that and avoid food XXXXXXX in Uric Acid. Any further thoughts before I close the discussion? XXXXX
Answered by Dr. Divya Agarwal 15 hours later
Brief Answer:
I would consider gout less likely

Detailed Answer:

Intermittent lower limb arthritis always has a possibility of gout. However in the absence of the typical acute attacks of arthritis, I usually do not consider gout as the first possibility. If at all there is any suspicion, then I order synovial fluid analysis. That's the only way to confirm - synovial fluid analysis would reveal urate crystals in case this is a gout.
If that is not a possibility then there is MRI called diffusion weighted MRI which can show deposits of uric acid crystals available to confirm gout.

I suggest you ask your doctor about these tests and confirm/exclude gout.

As you have high serum uric acid levels, dietary modification will help you to reduce the chances of metabolic syndrome.

I am available for clarifications.

Above answer was peer-reviewed by
Follow-up: Have had intermittent ankle pain radiating to calf and in femur. What is it? 32 minutes later
Thank you, I will follow this up with my GP and ask for the correct tests, I wish to examine both possibilities to get down to the bottom of it as the pain often keeps me awake even though it is mostly dull, boring and mild.

Could I ask clarification of this "metabolic syndrome", do you mean a change in my metabolism which would cause the real onset of gout? As I told you, I am, at the moment, just on the high side of the normal Uric Acid range, I have NOT exceeded it.

Grateful regards,

Answered by Dr. Divya Agarwal 5 minutes later
Brief Answer:
Not gout

Detailed Answer:

Metabolic syndrome is basically a constellation of high uric acid, impaired insulin tolerance , high cholesterol or blood pressure and obesity. I only meant, keeping your diet in control will also prevent these metabolic syndrome apart from controlling uric acid level. I did not mean that you have those now.

Above answer was peer-reviewed by
Follow-up: Have had intermittent ankle pain radiating to calf and in femur. What is it? 34 minutes later
That was a much needed clarification! Yes, I knew all that before and, fortunately, apart from mild BP, I do NOT have any of the other conditions but will seek to improve my nutrition and adopt a healthier lifestyle. You have been very helpful, thank you, I can close the discussion now.

Answered by Dr. Divya Agarwal 1 hour later
Brief Answer:

Detailed Answer:
you are welcome
Above answer was peer-reviewed by
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