Ankle Pain - Recreational Golfer

HISTORY: 56- year-old recreational golfer (187.96 cm, 81.64 kg) with no prior history of ankle injury reported with chief complaint of pain in the left ankle. Patient indicated that the ankle pain has been worsening over the past week. Patient indicates use of conservative treatment including NSAIDs and cryo-therapy. No mechanism of injury recalled and the patient states that the pain is limiting mobility. Initial treatment continued with cryotherapy, NSAIDs and MD referral that was previously scheduled before our examination. PHYSICAL EXAMINATION: Patient was examined in an university practice clinic. Patient presents with extreme pes planus. Obvious swelling along medial left ankle anterior of the medial malleolus. ROM in all planes grossly intact. Noted increased pain with active eversion. Strength 5/5, except for inversion 3+/5. Neuro = WNL. (-) Deltoid Stress Test, Ant/Post Drawer. No sign of subtalar joint involvement. No signs of fracture. Good capillary refill with all distal pulses strong. DIFFERENTIAL DIAGNOSIS: 1. Posterior Tibilais Strain 2. Flexor Digitorum Longus Strain 3. Deltoid Ligament Sprain 4. Stress Fracture distal tibia 5. Osteoarthrosis of the midfoot TEST AND RESULTS: Point of Care UltrasoundMagnetic Resonance Imaging without Contrast FINAL WORKING DIAGNOSIS: Mild to moderate distal tibialis posterior tendinopathy - tenosynovitis TREATMENT AND OUTCOMES: The patient underwent conservative treatment following his already scheduled MD appointment. This case presentation describes the successful use of point of care to aid the physical therapist and athletic trainer in confirming the physical assessment prior to MD referral and MRI.