Author: Steven Poon, MD
Co Author #1: Lindy Kyger, BS, LAT, ATC, MFDc
Co Author #2: Roger L. McCoy, MA, MD
Editor: Terra Blatnik, MD
Senior Editor: Kristine Karlson MD
33 year old otherwise healthy male who presents with 3 days of progressively worsening right ankle pain and swelling.
The patient worked as an operations member on the football coaching staff. He exercised daily and recalled running up and down stadium stairs as part of his workout while on a recent away football game trip, which occurred 2 days prior to pain onset. However, he noted no injury, fall, or other inciting event which coincided with the pain onset. The patient noted that he played Division 1 football and had various injuries but did not recall any specific foot or ankle injuries which caused him to miss playing time or require surgery.
Review of symptoms: He had no fevers, no vomiting, no night sweats, no constitutional symptoms.
Past Medical History: Chronic migraines, managed on medications and well controlled. HLA-B27 serotype positive with no formal diagnosis of spondyloarthropathy.
General: Pleasant, alert male
Musculoskeletal exam: Right ankle inspection with significant medial and anterior swelling extending from Achilles at the level of the medial malleolus anterior to the dorsal midfoot. There is slight erythema and warmth. Motion of the ankle is limited by stiffness but passive manipulation does not elicit pain. Medial ankle joint line is tender to palpation. There is pain with resisted dorsiflexion, plantarflexion, and inversion. No pain with testing of lateral structures.
Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.