Author: Jackson Massanelli, MD
Co Author #1: Jackson Massanelli MD
Co Author #2: Nicholas Stetkevich, DO
Senior Editor: Kristine Karlson, MD, FAMSSM
Editor: Ruikang (Kong Kong) Liu, MD

Patient Presentation:
A 10-year-old previously healthy boy with heel pain.

History:
A 10-year-old previously healthy boy presented to Sports Medicine clinic with a chief complaint of left heel pain. Symptoms started three days ago after jumping into a pool. He felt pain in his heel at the time but was able to keep playing. During the night, he woke up crying due to the pain. The pain was alleviated by Tylenol and Ibuprofen. He went to urgent care the following day and his pediatrician the subsequent day for his scheduled well check. X-rays were performed of his heel and were normal. Then his pain worsened to the point that he refused to move his foot, bear weight, and walk. Pain was located only at the heel. His mother denied swelling, weakness, paresthesia, transient paralysis, or other joint involvement at the time. By the time he presented to sports, he reported new right elbow pain over the last few hours.

Nine days prior to presentation, he developed a fever and sore throat that resolved after two days without treatment. Four days prior to presentation, he reported bilateral ear pain with intermittent fevers along with an intermittent erythematous truncal and upper extremity rash that also resolved with supportive care. Further review of systems was negative other than vomiting the day prior to presentation.

Physical Exam:
He was afebrile with normal vital signs. The physical exam was notable for exquisite tenderness to palpation of his left heel and Achilles tendon, limited range of motion in all planes, painful heel squeeze, and inability to bear weight on the affected foot. There were no noticeable color changes of the skin or swelling. He had severe right posterior elbow tenderness with erythema and warmth over the olecranon and limited range of motion. No obvious elbow swelling was noted. He had mild erythema of the oropharynx.

Due to intractable pain and concern for infectious etiology, the patient was sent to the ER for further evaluation.

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