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Photo Dx: Achilles Tendon Rupture? Tendonitis? Bursitis? Something Else?

Photo Dx: Achilles Tendon Rupture? Tendonitis? Bursitis? Something Else?

HISTORY
A 39-year-old man with right heel and lower leg pain comes to your office. The pain began last night during a basketball game. Another player had jumped and inadvertently landed on the back of the patient’s lower leg.

The patient is able to ambulate, although with difficulty because of the pain. He had no pain at the site before this injury, and he had never injured the right leg or foot in the past. He denies hearing a pop during the incident. No abrasions or ecchymoses are present in the area of the injury. While playing basketball, he was wearing sneakers he had owned for several months. His past medical history is significant only for depression, for which he takes citalopram.

PHYSICAL EXAMINATION
The patient is in no acute distress. There is an obvious asymmetry when the distal, posterior lower extremities are compared. The right lower extremity has diffuse edema, and a palpable groove proximal to the heel is evident. The area is tender. A Thompson test is performed bilaterally, with some flexion of the right foot but less flexion than the left foot.

WHAT’S YOUR DIAGNOSIS?

Answer on next page.

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