Author: Bret Namihas, MD
Co Author #1: Quincy Wang, MD
Senior Editor: Warren Bodine, DO, FAMSSM
Editor: James Robinson, MD

Patient Presentation:
An otherwise healthy, 16 y/o male, presented complaining of pain in the left ankle after playing soccer.

History:
A 16 year old male, soccer player with acute onset left achilles pain and swelling presented to our sports medicine clinic. The patient was playing soccer at the time of injury, 2 weeks prior to our evaluation. The patient stated that he attempted kicking the soccer ball with his right foot, slipped, and landed on his buttocks. He landed with his right knee extended, left knee in full flexion, and left ankle doriflexed. He was seen in the ED 2 days later, diagnosed with a left achilles tendon strain, given motrin, and placed in a CAM walking boot. We kept him in the boot for 1 more week, allowing for transition to street shoe as tolerated thereafter. At follow up 1 month later, his pain had resolved, and he had returned to play. He did, however, complain of intermittent numbness of the left toes when kicking the ball. He stated that with maximum plantar ankle flexion, his toes felt numb. This would resolve as soon as his ankle was dorsiflexed back into a neutral position. He was unable to recall which toes in particular would go numb, or for how long this symptom had been present.

Physical Exam:
Left ankle examination: No effusion or no ecchymosis present. Mild tenderness of the Achilles tendon, superior to the insertion of the calcaneus. Range of motion: dorsiflexion 10 degrees plantarflexion 40 degrees inversion 15 degrees eversion 10 degrees Strength: plantar flexion, extension, inversion and eversion 5/5. Negative Thompson. Negative anterior drawer. Negative talar tilt.

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