Severe lower leg pain, inability to plantarflex, and inability to walk on toes after pushing off is most consistent with which injury?

Severe lower leg pain, inability to plantarflex, and inability to walk on toes after pushing off is most consistent with which injury?

• A. Calf strain
• B. Ankle sprain
• C. Tibial fracture
• D. Achilles tendon rupture

Answer: (D)

The ability to push off and plantarflex the foot is powered mainly by the Achilles tendon. If that tendon ruptures, the strength to point the toes or rise onto the ball of the foot is lost, producing severe pain and an inability to walk on tiptoes right after the push-off. This makes an Achilles tendon rupture the most likely diagnosis. Calf strain can weaken plantarflexion but usually doesn’t eliminate it entirely. An ankle sprain involves ligament injury around the ankle and typically preserves some plantarflexion, with pain and swelling localized to the ankle. A tibial fracture causes severe pain and often obvious deformity at the bone, but the hallmark functional loss described here—inability to plantarflex and to walk on toes after a push-off—points most specifically to rupture of the Achilles tendon. Imaging or a Thompson test can confirm the rupture if needed.

The ability to push off and plantarflex the foot is powered mainly by the Achilles tendon. If that tendon ruptures, the strength to point the toes or rise onto the ball of the foot is lost, producing severe pain and an inability to walk on tiptoes right after the push-off. This makes an Achilles tendon rupture the most likely diagnosis.

Calf strain can weaken plantarflexion but usually doesn’t eliminate it entirely. An ankle sprain involves ligament injury around the ankle and typically preserves some plantarflexion, with pain and swelling localized to the ankle. A tibial fracture causes severe pain and often obvious deformity at the bone, but the hallmark functional loss described here—inability to plantarflex and to walk on toes after a push-off—points most specifically to rupture of the Achilles tendon. Imaging or a Thompson test can confirm the rupture if needed.