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An Uncommon Opponent: A Unique Case Of Acute Ankle Pain In A Youth Soccer Player - Page #1
 

Author: Jennifer Su, MD
Co Author #1: Raymond C. Guo, MD
Co Author #2: Stephanie DeLuca, MS, MD
Senior Editor: Drew Duerson, MD
Editor: Moneeb Akhtar, MD

Patient Presentation:
Acute right ankle pain

History:
A 9-year-old female soccer player with no significant past medical history developed acute, atraumatic right ankle pain after playing soccer. There was no significant swelling or bruising. She was evaluated at an orthopedic urgent care center, where plain radiographs of the right ankle were negative. She was diagnosed with a lateral ankle sprain and placed in a walking boot.

A few days later, she developed fevers and nighttime right ankle pain. She was otherwise in her usual state of health and was evaluated by her pediatrician, where a viral panel was negative.

Five days after the initial onset of symptoms, she presented to an outpatient pediatric sports medicine clinic with progressively worsening right ankle pain. She was no longer able to bear weight because of pain and required a stroller for mobility. Fevers up to 103 degrees Fahrenheit persisted without other systemic symptoms or known sick contacts.

Physical Exam:
On examination, the patient appeared nontoxic and in no acute distress.

Inspection revealed swelling and mild erythema localized to the lateral aspect of the right ankle without ecchymosis.

Palpation elicited exquisite tenderness to light touch over the lateral malleolus and lateral ankle ligaments, reproducing her index pain.

Active and passive range of motion, as well as strength testing, were markedly limited in all planes because of pain.

Distal neurovascular examination was normal. The patient was unable to bear weight because of significant pain.

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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