A Specific Diagnosis is Not Necessary

I recently saw a patient for an initial evaluation who had a diagnosis of ankle instability. She is a college student who has had ankle pain for three years now, and she has seen two orthopedic surgeons and two podiatrists to try to figure out her ankle problem. (Never a referral to physical therapy in all those years, ahem.)

She started having pain in her ankle about three years ago, and she cannot recall a specific injury that started the pain. Her symptoms are worse with running and jumping, and her ankle feels better with rest.

Her mother, who is very concerned about her daughter's ankle, attended the first physical therapy appointment. She asked quite a few very good questions, and was asking about a specific diagnosis for her daughter.

It seems one orthopedist said she had a small bone chip in her ankle. Another doctor gave her the ankle instability diagnosis. One podiatrist diagnosed her with fallen arches and made orthotics for the young woman. Another podiatrist diagnosed her with tendonitis in her ankle and taped her foot.

I examined my patient and found a mild weakness in the ankle muscles that turn her foot in, and perhaps a very slight decrease in arch height on the painful side. I also found that she had weak hip muscles, especially in abduction and external rotation. Recently, many studies are focused on abnormal hip function as a culprit in many lower extremity problems.

After my examination my patient's mother asked me what my diagnosis is. I told her my diagnosis: non-specific foot and ankle pain of unknown origin with slight weakness in her ankle and significant weakness in her hips.

Wait. Is that really a diagnosis? Shouldn't the diagnosis be something like bursitis, tendonitis, arthritis, or anything else with an -itis or -osis on the end?

Not really.

My diagnosis is just as valid as any other she has had in the past few years. So it is not a diagnosis that implicates a tendon, bursa, or ligament. It doesn't imply inflammation or arthritis. My diagnosis simply tells an accurate story of this patient's problem, and my assessment of the situation gives me a good idea of what we need to work on to hopefully improve this person's condition.

Many times patients ask me if they need to see their doctor for a specific diagnosis before starting physical therapy. Many times, I get patients with referrals to physical therapy that say, "Shoulder pain." That diagnosis is a pretty good one, considering the patient probably showed up to their doctor's office and said, "I have shoulder pain."

If you are having a problem or pain that is causing difficulty with mobility, a visit to your doctor is not a bad idea. But to really get to the crux of your movement dysfunction, a visit to your physical therapist is probably the best idea.