F-22I Clinical Case Slide Presentation Multiple Sports Foot Pain
An 18 year old women's basketball player in her freshman year presented to the training room after a recent road trip with a three week history of right midfoot pain. She denied any specific injury to the right foot. She stated the pain began approximately three weeks prior to her presentation to the training room and that the pain had been progressing, particularly with ambulation. She had played in only four games her freshman year, and the schedule included three recent road trips in which practices and conditioning had been light intensity. She denied any numbness, tingling, weakness, or radiation of pain.
Initial examination in the training room revealed moderate tenderness over the medial, dorsal aspect of the right foot. There were no skin changes or ecchymosis. She had full range of motion and strength in her ankle and foot. Her right lower extremity was neurovascularly intact throughout.
1. Tarsal navicular stress fracture.
2. Foot sprain.
3. Other tarsal stress fractures.
4. Tarsal coalition.
TESTS AND RESULTS
Right foot radiograghs - AP, lateral, and oblique - no evidence of fractures or dislocations MRI right foot - subacute, nondisplaced fracture of the dorsal, lateral aspect of the navicular bone.
Navicular stress fracture.
TREATMENT AND OUTCOME
1. Immobilization and nonweightbearing for eight weeks with continued pain.
2. Repeat radiograghs demonstrated unusual sclerosis and dorsal spurring.
3. Continued immobilization and addition of a bone stimulator for eight weeks with continued pain.
4. Repeat radiograghs demonstrated increased sclerosis in the dorsal aspect of the navicular bone.
5. The athlete remained frustrated with her continued pain and lack of progress, and a CT scan was ordered showing poor evidence of healing with peri-fracture sclerosis and delayed healing.
6. Open reduction and internal fixation of the navicular bone was performed with two threaded screws without complications. The athlete was treated with immobilization and nonweightbearing for 8 weeks without any post-operative complications.
7. Radiographs, 4 weeks after surgery, showed some sclerosis.
8. Despite 8 weeks of immobilization and nonweightbearing, the athlete developed pain with the resumption of ambulation, and repeat radiograghs showed loose screws and no healing.
9. Open reduction and internal fixation with a threaded screw and tibial bone graft was performed. The athlete was treated with immobilization and nonweightbearing for eight weeks.
10. Repeat CT scan approximately 7 weeks post-operatively showed bone bridging across the lateral half of the fracture site.
11. 12 weeks after the second surgery, she is doing well with only minimal discomfort.