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Hal, a 50 year old politician, was a college basketball player and stayed fairly active with sports and weekend pickup games through his thirties and early forties (Q1) Having a members only gym near his office facilitated this practice. However, intense campaigning and successful election to the US Congress meant extra travel, fried chicken dinners, hotel rooms and prolonged sitting and weight gain. After years of relative inactivity, with only sporadic visits to the gym, Hal participates in an intense basketball game. Midway through the game, he collapses suddenly with a sharp pain behind the right ankle (Q2). While he is on the floor, the pain eases, and he is able to move his ankle and food reasonably well. But when he tries to stand, his ankle is very weak and painful.

He proceeds (hopping) to a physician. One examination, there is normal and painless range of motion in his right hip, knee and toes. With his right leg dangling, he can flex (dorsiflex) and extend (plantar flex) the ankle with only minimal pain (Q3 and Q4). The region posterior to the ankle and proximal to the heel is swollen and tender (Q5) When he lies prone, with the right knee bent there is a palpable depression posterior to the ankle, extending toward the knee. Grasping and compressing the calf muscles of the normal left leg produces and ankle extension reflex (plantar flexion), but doing this with the right leg has no motion of the ankle joint (Q6)

Answer the following questions regarding this scenario
1) What are the effects of aging and reduced levels of activity on the system critical to the performance of athletic activities? How do these effects interact?
2) List at least three possible causes of the ankle problem and relate them to the relevant factors from question 1.
3) What is the significance of the reduction in pain and Hals ability to move the ankle and food when he is not standing?
4) What does this tell the physician about the nature of the injury?
5) What structures are located in that region?
6) What does this mean, and what was the final diagnosis? Why was Hal still able to extend the ankle when it was not bearing weight? Be sure to cite your references if you use outside sources.

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