Brad, a 35-year old male accountant, presents to the primary care office with a chief complaint of “sudden left ankle pain while playing basketball” the day before. While jumping up to catch a rebound, he says he felt as if he was kicked behind the ankle. He heard a “pop” of his left ankle and was unable to continue due to the pain. Since the onset of pain, Brad has had difficulty with weightbearing and climbing stairs.

Soft tissue rheumatism is a collection of nonarticular pain generators that result from pathology of extraarticular and extraosseous periarticular structures. These soft tissue structures include bursae, tendons and their synovial sheaths, entheses, muscles and fasciae. The focal point to soft tissue rheumatism is that pain is not due to pathology of structures within the true joint (i.e., arthritis). Soft tissue rheumatism may manifest itself as well defined pathology of a single periarticular site or a regional myofascial pain syndrome.

Ankle pain can be associated with swelling, stiffness, redness, and warmth in the involved area, and it is commonly caused by a sprain or fracture. Sprains and fractures are typically due to accidental falls or sports injury, particularly in sport with jumping and quick direction changes like basketball, football, and soccer. Any bone injury near a joint may injure the growth plate (physis) in a child and needs to be evaluated. An orthopedic surgeon should be consulted, especially in pediatric injuries, and physical therapy may be required to ensure proper healing.