Author: Joseph Friedli, MD
Co Author #1: James L. Moeller, MD, FAMSSM
Senior Editor: Drew Duerson, MD
Editor: Zoe Foster, MD
Patient Presentation:
A 52-year-old male presented to the Sports Medicine clinic for evaluation of 6 months of left ankle pain. He denied any history of injury or trauma. He first noticed the pain while running a half-marathon, and it became severe enough that he could not finish the race. His pain had an insidious onset and was reported as a deep-seated, dull ache in the left fibula proximal to the lateral malleolus. Pain did not improve with conservative measures such as rest, ice, compression, elevation, and over-the-counter analgesics. The patient reported increased pain with activities such as running and skiing. He denied ankle instability, swelling, or radiation of symptoms to his foot or knee. He denied constitutional symptoms such as fevers, chills, night sweats, and unintentional weight loss.
History:
No relevant past medical or surgical history.
Physical Exam:
52-year-old male in no acute distress and with normal gait. No skin changes or swelling of the left lower extremity. No bony tenderness upon palpation of the left ankle or lower leg. Full range of motion in the left ankle with dorsiflexion and plantarflexion. Negative anterior drawer test. 5/5 strength with inversion, eversion, dorsiflexion, and plantarflexion. Neurological exam revealed 2+ Achilles tendon reflex, and sensation of the lower extremities was intact to light touch. Normal distal pulses.
Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.