F-22I Clinical Case Slide Presentation Multiple Sports Foot Pain
A 17- year old junior football player presented with right foot pain during preparticipation physicals. The pain had started several months earlier during summer baseball, but there was no history of injury or trauma to the foot or ankle. The pain was located in the anterior ankle and midfoot region and would increase during baseball games. The patient initially attributed his pain to poor footwear and purchased new baseball cleats. Despite this, his symptoms gradually worsened over the course of the summer until he was unable to complete a full game secondary to the pain. The pain increased with ambulation and was relieved by rest. After several weeks of rest between summer baseball and high school football, the patient's pain had almost completely resolved. When attempting to return to running just prior to football season, the patient found that his pain quickly returned and the was unable to compete.
Examination of his feet revealed no obvious swelling or deformity. Both feet were neurovascularly intact. He had equal ROM in the ankle joints, with only extreme dorsiflexion causing any discomfort on the right. There was tenderness to palpation medially along the anterior joint line of the right ankle, but no tenderness was elicited in the midfoot or forefoot region. There were no other significant findings on exam.
- Anterior impingement of the ankle.
- Talar stress fracture.
- Osteochondritis Dissecans of the talus.
- Atypical ankle sprain.
- Referred pain.
TESTS AND RESULTS
Radiographs R ankle/foot: -No fracture -Small amount of anterior spurring -Os trigonum Bone Scan: - increased uptake R midfoot/navicular area MRI: Fracture navicular bone.
FINAL WORKING DIAGNOSIS
Navicular stress Fracture.
TREATMENT AND OUTCOMES
- Non- weight bearing in boot for 8 weeks.
- Patient continued to have pain.
- External bone stimulator applied.
- Considered for surgical intervention - screw fixation if symptoms persist and no radiographic evidence of bone healing.