The patient is a 23-year-old male who presents with a complaint of pain in the heel area after slipping down four steps. He is limping but able to bear weight. On exam, you note local tenderness and swelling over the area of the Achilles tendon. Other findings are unremarkable.

View the x-ray taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.

Clinical Challenge: November, 2008

Nahum Kovalski, BSc, MDCM

Clinical Researcher at TEREM Emergency Services
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