Suggest Treatment For Ankle Pain

Posted on Thu, 4 May 2017

Question: Hi
My wife who is 30 years old( 65 KG;5ft 2 inch) is suffering from ankle joint pain for last few months. Recently as per doctor's advice she had done all relevant tests and found that Calcium is normal range (9.1) but have Vitamin D deficiency (Around 8.1 and its summer time in XXXXXXX though she is not at all exposed to Sun ).
She also undergone BMD test with peripheral device in foot which gave T Score as (-1.2) which is in Osteopenia range. She never had any fracture in her life.
She has been prescribed with
1. Calcium carbonate + Calcitriol + Zinc : Twice daily
2. Calciferol (60000) :one a week
3. Carniture (Levocarnitine) : Twice daily
4. Some pain killer.

Now below are my questions:
1. Is prescribed medicine sufficient for her need? Are dsoges are correct?
2. With these medicines and good diet and exercise, is it possible to goes back to normal t score range or damage already happened is permanent and we can only slow the process?
3. Is it necessary to do proper BMD test done but my doctor said not required looking at her age.
4. Is it necessary to start Fosomax or related medicine ?
5. After starting Vitamin D supplements the pain increased. I heard its normal.
6. Any other suggestion you might have or how many days after she will feed good.

Answered by Dr. Dr. Gopal (28 minutes later)

Brief Answer:
The treatment is ok but thecause of ankle pain is to be investigated.

Detailed Answer:
Hi XXXX , I am Dr Gopal Goel , Orthopedic Surgeon.
By the description and your requirements , it seems that you want to more know about the osteopenia than her ankle pain.
She has hypovitaminosis D for sure , but peripheral BMD , in my opinion is not reliable . If BMD is to be measured , then it is only with Dexa scan , though since your wife is quite young(30) Dexa is not recommended , in fact BMD measurements are not as relevant in her case.
The treatment instituted in her case is adequate. As far as BMD returning to normal- -1.2 is not significant loss , and I would advise for normal milk intake and 30 min exposure to sun early morning / late evening after the Vit D3 levels come to normal.
Now we have to find the cause of ankle pain. Please get an X ray and if it is normal go for MRI to find out any local cause of ankle pain.
Thanx for the question. Please feel free to ask any other question.

Above answer was peer-reviewed by : Dr. Remy Koshy

Follow up: Dr. Dr. Gopal (30 minutes later)

Thanks doctor for your suggestions !
And yes I am very much worried(even more than pain) when Osteopenia was diagnosed at such a early age which might easily go towards Osteoperosis.

X rays were done and nothing significant was found.
Due to this BMD tests been done after low Vitamin D results, I tend to believe that Osteopenia / Osteomalacia( As she has hypovitaminosis D ) is the main culprit behind the pain. Do you think any other cause might be associated?

To mention, she used to take the baby in her lap to make our baby sleep for last 2.5 years and my baby takes lot to time before asleep which cause pressure in her ankle.

Answered by Dr. Dr. Gopal (10 minutes later)

Brief Answer:
Please take orthopedic consultation.

Detailed Answer:
Hi XXXX,
I am Dr Gopal Goel, Orthopedic Surgeon.

Hypo vitaminosis D is normally not the cause of ankle pain. Ankle pain could be due to local cause like plantar fasciitis , sprain etc or it can a referred pain coming from back, hip or knee .

With the description provided by you, it cannot reach at any conclusion. I will suggest consultation with a orthopedic surgeon for examination and proper diagnosis. The treatment will depend on diagnosis.

Thanks for the question.

Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.

Above answer was peer-reviewed by : Dr. Vaishalee Punj