Imaging quiz posterior ankle pain in a recreational athlete

A 21-year-old male recreational soccer player presented with right posterolateral ankle pain of 4 weeks' duration that was provoked by prolonged weight-bearing and significant plantar flexion. Running, jumping, and kicking the ball exacerbated the pain. On physical examination, tenderness was noted anterolateral to the Achilles tendon and posterior to the talus. Resisted plantar flexion accentuated the pain. Anteroposterior, lateral, and mortise view radiographs revealed no bony lesions. A technetium 99m methylene diphosphonate bone scan (figure 1) was then obtained.