Case 2

Patient basic data: Sarah S., female, dob 01.01.1993, (27 y/o), not pregnant, non-smoking, no treated hypertension, or diabetes.

Symptom: Pain in left Ankle (joint)

Fictional diagnosis: Ankle sprain (distortion of the anterior fibulotalar ligament) left

History: 2 h earlier, the patient had twisted her left foot during volleyball causing supination trauma. With immediate onset of pain, she had stopped playing and limped to the side bench under careful axial load on her left leg. A teammate had given her an ice pack, so she had iced and slightly elevated the leg. Above the lateral ankle a larger swelling has formed, she doesn’t dare attempt full weightbearing anymore, because it is quite painful, which she subjectively reports as “strong” (VAS 8). Worried about a more serious injury, she now uses the app.

Examination results: Swelling in the area of the anterior fibulotalar ligament, pressure pain at the anterior distal tip of the lateral malleolus, no pressure pain over syndesmosis or high fibula, muscles of the calf, medial malleolus, deltoid ligament or foot skeleton. Mobility limited due to pain, pronation still possible at approx. 5°, supination associated with pain, dorsal extension/plantar flexion approx. 10°, no wounds, no hematoma visible, peripheral circulation and sensitivity intact (motor function just restricted in the ankle joint).

Not anticipated while creating the vignette: N/A

Answers suspected not to be answered by the fictional patient: “Do you feel that your ankle is instable?”

Number of symptom-related questions: 29

General app estimation (“next steps”): People with symptoms similar to yours may require emergency care. If you think this is an emergency you should go to an emergency department without delay.

Suggested diagnoses: 1. Sprained ankle without ligament rupture (seek emergency care): 3 out of 10 people with these symptoms had this condition 2. Lateral malleolus fracture (seek emergency care): 2 out of 10 people with these symptoms had this condition 3. Lateral ligament rupture of the ankle (seek emergency care): 2 out of 10 people with these symptoms had this condition 4. Ankle fracture, not further specified (seek emergency care): 1 out of 10 people with these symptoms had this condition

Note: N/A