A 31-year-old Asian man presented for evaluation of left foot pain that began on the day before his clinic visit while he was practicing parkour (the physical discipline of training to overcome obstacles within one’s path by using only the human body and objects in the environment). He had no significant medical history. The patient recalled leaping from a platform toward a horizontal bar attached to a wall a few feet away. During the lift-off phase of the jump, he experienced a snapping sensation in his left foot, with subsequent pain in the arch and heel. Immediately after this event, he was unable to ambulate.
The patient denied any recent trauma or any use of corticosteroids or fluoroquinolones in his lifetime. He did have a long-term history of intermittent and alternating aches on the heels of his feet. However, he had experienced pain in only his right (opposite) foot in the weeks before this acute injury.
The patient arrived at our office on crutches with an elastic bandage wrapped around his left midfoot and ankle. Visual inspection revealed minimal ecchymosis and mild swelling along his left heel and arch. He demonstrated an antalgic gait, with worsened pain on resisted dorsiflexion of the left foot.
The patient was neurovascularly intact, with normal strength of both feet and ankles. No palpable masses were appreciated. The Achilles tendon was intact and nontender, with a normal Thompson squeeze test result (while the patient lies prone with both feet extending past the end of the table, the clinician squeezes the calf of the affected leg; plantar flexion suggests normal Achilles tendon response, and a lack indicates Achilles tendon rupture). Findings from the remainder of the examination of both feet and ankles were unremarkable.
A lateral x-ray film of the patient’s left foot (above, left) and a sagittal MRI scan with short tau inversion recovery (STIR) sequences (below, left) were obtained and are shown.
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