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Achilles Pain

 

UNFINISHED CASE: COME BACK LATER 

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History of Present Illness:

  • A 32-year-old male presents to the ED for right Achilles pain which she’s had for the last 2 days. She denies any injury or significant overuse although she had been jogging a little more than her baseline recently.
  • She denies any fever. She denies any new footwear or new medications

Vital Signs & Physical Exam:

  • Vital signs are normal.
  • Physical exam is normal except for mild warmth tenderness and swelling to the ankle and anterior foot.  However she not tender there.  She is only tender in the Achilles area, which does not actually appear swollen. There are a couple of completely healed scabs or abrasions with no evidence of any redness or drainage.  (See images below.  the patient’s right side is the symptomatic side.)

Initial Differential Diagnosis:

  • Cellulitis
  • Septic Joint
  • Gout
  • Tendonitis

Initial Diagnostic Testing:

  • X-ray and labs were normal

QUESTIONS:

  1. What does the case image show?  (click two times to enlarge)
  2. What should you do next?  
  3. Where can one get a quick refresher on this topic?  

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ANSWERS:

  1. What does the case image image show?  The image shows foot swelling that is mild
  2. What should you do next?  Make sure she is not on a quinolone and consult orthopedics.  It was decided to get an urgent MRI, which confirmed inflammatory changes of the lower Achilles tendon.  There was no cellulitis or joint effusion.  See case conclusion below tutorial page-shot.
  3. Where can one get a quick refresher on this topic?  See yellow highlighted area below from a page of our purple book.

1-Minute EM Consult on the topic for this case from the Emergency Medicine 1-minute Consult Pocketbook

 

 

CLICK HERE TO BUY THE BOOK THE PAGE ABOVE COMES FROM

CASE CONCLUSION: Discharged home with crutches and orthopedic follow up.

 

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