Patient unable to stand on toes of affected foot What is the most likely diagnosis?

A 26-year-old woman who was recently diagnosed with a urinary tract infection (UTI) presents with the sudden onset of severe lower calf and ankle pain in her left leg. The patient states that she was running in a marathon, and at mile 22, she heard a loud popping sound and felt like she had been shot in the back of the left leg. Meds: • Ciprofloxacin • Oral contraceptive pills (OCPs) ROS: • Limping • Unable to walk Physical Exam: • Gastrosoleus complex muscle is tender, warm, and bruised • Excessive dorsiflexion of the affected leg • No passive plantar flexion of the foot with calf squeeze • Patient unable to stand on toes of affected foot
What is the most likely diagnosis?

a. Ruptured Baker’s cyst
b. Achilles tendon rupture
c. Ankle fracture
d. Reactive arthritis
e. Deep venous thrombosis (DVT)

Answer b. Achilles tendon rupture A patient with an Achilles tendon rupture presents with a sudden snap in the lower calf associated with acute, severe pain and an inability to walk. The patient is unable to walk and has two significant physical examination findings. The first is hyperdorsiflexion, in which the foot has excessive dorsiflexion, and a positive Thompson test result, when squeezing the calf does yield plantar flexion. A ruptured Baker’s cyst presents with pain behind the knee, and reactive arthritis is the classic “can’t pee, can’t see, can’t climb a tree” after urethritis or UTI. A DVT presents with unilateral swelling and a palpable cord in the back of the leg, with pain upon dorsiflexion.
The main blood supply is derived from both long and short component of the vincula.
The Achilles tendon is formed from the tendons of the gastrocnemius and soleus muscles.