No, Not My Achilles Again! - Page #1

Author: Matthew Heitzenrater, DO
Co Author #1: Dr. Laura McIntosh
Editor: Tenley Murphy, MD
Senior Editor: Margaret E Gibson, MD

Patient Presentation:
Chief complaint of left ankle swelling after exercise.

39 y/o male, avid runner and cyclist, presents with left heel swelling after exercise including: running, walking, cycling. There was no ankle pain while exercising. No history of trauma, ankle giving out on him, grinding sensations with activity, or night pains. No complaint of weakness in the ankle. He has a history of a prior right achilles tendon rupture and his major concern was for new onset left Achilles pathology.

Physical Exam:
Posterior L heel edema noted in prone position with feet hanging off table.
L Achilles tenderness to palpation at 3cm above its insertion point, no palpable tendon thickening.
Visible posterior ankle effusion that becomes more prominent with ankle dorsiflexion
No pain at end ROM
Strength 5/5 in all ankle ranges of motion
Sensation equal bilaterally in foot and toes
Dorsalis Pedis Pulse: 2/2; Capillary Refill WNL

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