A 12-year-old boy presented with the chief complaint of severe right ankle pain. The football player noticed the pain after a game three weeks before. He said he may have taken a “bad step” on the grass while running toward a ball. It did not affect his play at the time but he was limping after the game. The patient described the pain as aching and throbbing, and rated the pain at 6/10 on a 10-point pain scale.
Home treatment included ice and rest but the pain continued to persist. Physical Exam: Mild edema to the anteromedial aspect of the ankle joint with severe pain on palpation over the anteromedial aspect of the distal tibia epiphysis. There was mild pain with range of motion of the ankle joint and no pain with inversion or eversion of the foot. There was pain with palpation along the distal aspect of the Achilles tendon at its insertion, which extended 2 to 3 cm proximally with…
