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A Back-peddling Bone Buster - Page #1
 

Author: Robert Bogart, DO
Co Author #1: Dr. Rick Mullins, MD
Co Author #2: Dr. Arthur Islas, MD
Co Author #3: Dr. Mark Stovak, MD
Senior Editor: Kristine Karlson, MD, FAMSSM
Editor: Drew Duerson, MD

Patient Presentation:
Left ankle pain.

History:
A Division I football player presented complaining of posteromedial left ankle pain which abruptly developed while backpedaling during the third quarter of a football game. During the sideline evaluation, the patient reported feeling a crack with subsequent development of medial ankle pain and inability to bear weight. He did not sustain any direct contact to his ankle and denies any twisting or rolling mechanisms. He was not experiencing any left ankle pain prior to the football game. The patient had no prior history of trauma or surgery to his left ankle. Initial X-rays were unremarkable. Five days later the patient was still unable to bear weight and an MRI was ordered.

Physical Exam:
Antalgic gait. No erythema, ecchymosis, edema or gross deformity. Active range of motion demonstrated 15 degrees of dorsiflexion, 30 degrees of plantar flexion, 20 degrees inversion and 5 degrees of eversion with mildly discernible discomfort with resisted inversion and dorsiflexion. Discomfort more severe with dorsiflexion when compared to inversion. Mild tenderness to palpation along the posterior tibialis tendon, deltoid ligament and medial malleolus. No tenderness along the lateral malleolus, navicular, base of 5th metatarsal, achilles tendon or fibular head. Negative squeeze test, negative dorsiflexion external rotation test, negative talar tilt test, negative anterior drawer test.

Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.

NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.
 

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