American Board of Internal Medicine (ABIM) Certification Practice Exam

When an individual hears a popping sound in the heel during strenuous activity, what is the likely condition?

1. Achilles tendinopathy

2. Morton neuroma

3. Plantar fasciitis

4. Achilles tendon rupture

The correct answer is: Achilles tendon rupture

When an individual experiences a popping sound in the heel during strenuous activity, it is most commonly associated with an Achilles tendon rupture. This sudden and often loud sound occurs as the Achilles tendon, which connects the calf muscles to the heel bone, tears. This condition typically presents with acute pain in the back of the ankle or heel, along with swelling and difficulty in plantar flexion (pointing the toe) following the injury. The other conditions mentioned, although they can cause heel pain, do not typically present with a popping sound. Achilles tendinopathy is characterized by chronic pain and stiffness in the tendon, typically developing over time rather than suddenly. Morton neuroma is a condition affecting the nerves between the toes and does not relate to sounds from the heel region. Plantar fasciitis involves pain in the plantar fascia, usually at the bottom of the foot, and does not cause a popping sensation. Thus, the scenario described clearly aligns with an Achilles tendon rupture.