Author: Benjamin Jackson, D.O.
Co Author #1: Dr. Michael Smolka, D.O. Fellow at Campbell University Sports Medicine Fellowship
Co Author #2: Dr. Andrew Martin, D.O., FAOASM Program Director at Campbell University Sports Medicine Fellowship
Senior Editor: Margaret Gibson, MD, FAMSSM

History:
A 24 year old female ROTC college student with a past medical history of nicotine abuse by vaping fell off of her skateboard and planted her left foot for support. She felt her ankle invert causing her to stumble to the ground. She had difficulty ambulating and had lateral ankle swelling immediately after the fall, so she went to a local urgent care. Non-weight bearing left ankle x-rays were read as no acute findings, and she was told to use PRICE therapy. The patient did not recall any left knee pain at initial evaluation and did not remember a knee exam being performed. The patient continued to experience lateral ankle pain and new onset lateral left knee pain with normal activity progressing over the next several weeks. She presented to our clinic for the first time 3 weeks after the initial injury.

Physical Exam:
Left foot and ankle exhibited moderate swelling without bruising over lateral ankle and tenderness to palpation over lateral malleolus. No tenderness to palpation of 5th metatarsal or navicular. Anterior and posterior drawer tests were normal and compatible with the right ankle. Squeeze test was negative.
Left knee exam found significant tenderness to palpation of proximal fibular shaft with overlying bruising. There was no LCL laxity or pain with varus knee stressing. Fibular (peroneal) nerve did not appear to be injured as eversion and dorsiflexion did not illicit pain and lower extremity sensation was intact.
Patient could take 4 steps with mild discomfort at the lateral left ankle and knee. There was no clear disfunction or deformity of fibular head, however pain was elicited with anterior/posterior fibular head glide.

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