Author: Charles Litchfield, MD, MS
Senior Editor: Margaret Gibson, MD, FAMSSM
Editor: Theodros Zemanuel, DO

History:
A 68 year old female who was isolating at home during the pandemic presented to the sports medicine clinic with the chief complaint of persistent right lower extremity pain. She had been exercising at home during the pandemic employing many alternative methods for staying in shape and recently started a new regimen of weighted stair climbs using a case of water acting as a 30 pound weight. She has been carrying this additional weight in front of her as she went up and downstairs. She was most interested in increasing her quadriceps strength. During one set, as she was mounting the final stair, she felt herself begin to pitch forward. Without thinking, she stood up straight very quickly as a reflex and felt an immediate and sharp pain in her left leg. She noticed a small indentation in her calf soon after the injury, followed by progressive swelling. She was seen in the emergency department for initial evaluation including doppler ultrasound (US) evaluation for deep venous thrombosis (DVT), that was negative. She was subsequently referred to sports medicine clinic for follow-up.

Physical Exam:
General: middle aged female in no acute distress
Cardiac: non-tachycardic, mildly hypertensive
Left lower extremity: swelling with ecchymosis compared to right lower extremity most prominent in the proximal calf, also noted in ipsilateral ankle. No erythema or warmth. No deformity. Mildly antalgic gait. Tender to palpation at the proximal third of calf at the medial aspect and distal third in the posterior midline. Achilles tendon palpably intact along its course into muscle belly. Full range of motion at knee, hip, and ankle but with calf pain at extremes of knee flexion and extension. Pain with resisted plantar flexion of the foot. Knee ligaments stable. Positive Homan’s sign. Positive Pratt’s test. Negative Thompson test. Negative Matles test.

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