Author: Harris Syed, MD
Co Author #1: Timothy W Thomsen, MD
Senior Editor: Carolyn Landsberg, MD
Editor: Adam Lewno, DO

Patient Presentation:
A 17-year-old male presented with acute right ankle pain.

History:
A 17-year-old male presented with a chief complaint of one day history of right ankle pain. While playing in a 7 versus 7 football scrimmage the evening prior to presentation, he suffered an inversion ankle injury with immediate onset of moderate to severe ankle pain. He described the pain as sharp with radiation along the front of his shin and down into his foot. There was mild swelling, but no bruising.  He had not been able to weight-bear since the time of injury.

Past medical history significant for a right anterior cruciate ligament reconstruction, right olecranon fracture requiring open reduction with internal fixation, and a non-operative thumb fracture.

Physical Exam:
General: Healthy, well nourished male, no acute distress
Inspection: No erythema, skin discoloration, or swelling
Palpation: Tender to palpation over the distal tibial shaft and anterior inferior tibiofibular ligament (AITFL). There was no pain over the proximal fibular head, distal fibular shaft, fifth metatarsal head, navicular, cuboid, distribution of peroneals, posterior tibialis tendon. Additionally there was no pain with calcaneal squeeze.
Range of Motion: 20 degrees dorsiflexion, 40 degrees plantarflexion, 20 degrees of inversion and 10 degrees of eversion
Strength: 4+/5 with resisted dorsiflexion, plantarflexion, inversion/eversion.  
Neurologic: Sensation intact to light touch in the superficial fibular, deep fibular, sural, tibial and saphenous distributions.  
Special testing: Negative anterior drawer and talar tilt. Painful with external rotatory torque.

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