9 Year Old Female Athlete With Ankle Pain

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9 Year Old Female Athlete With Ankle Pain - Page #4

Working Diagnosis: Left Ankle: Osteochondritis dissecans distal tibial epiphysis with 1 cm leg length discrepancy. Right Foot and Ankle: Reactive bone edema due to altered biomechanics Treatment: Patient was made non-weightbearing and placed into a short leg cast on the left for 6 weeks. This was followed by 2 weeks in a walking cast. After cast removal she progressed to rehab and gradual return to activity. Outcome: Left medial ankle was tender 3 weeks after casting. The Right foot and ankle remained nontender. Repeat left ankle x-rays was done at 6 weeks and MRI at 3 months. She did physical therapy for ROM, core strength, running/gait training. She may need possible surgical intervention for chronic pain Author's Comments: OCD lesions are generally unilateral as it is a disorder of the talar or distal tibial subchondral bone and articular cartilage. Incidence in children is not clearly well known. Editor's Comments: It is important to pursue more advanced imaging if a patient has persistent symptoms despite the typical treatment of immobilization and physical therapy. This is especially important in a growing athlete. Some osteochondral defects can go undetected on plain xray. References: Kessler J, Weiss J, Nikizad H, Gyurdzhyan S, Jacobs J Jr, Bebchuk J, Shea K. Osteochondritis dissecans of the ankle in children and adolescents: demographics and epidemiology. Am J Sports Med. 2014, 42(9), 2165-2171. Thacker M, Dabney K, Mackenzie W. Osteochondritis dissecans of the talar head: natural history and review of literature. J Pediatr Orthop B. 2012, 21(4), 373-376. Weiss J, Nikizad H, Shea K, Gyurdzhyan S, Jacobs J, Cannamela P, Kessler J. The Incidence of Surgery in Osteochondritis Dissecans in Children and Adolescents. Orthop J Sports Med. 2016, 4(3), 1-7. Zbojniewicz A, Laor T. Imaging of osteochondritis dissecans. Clin Sports Med. 2014, 33(2), 221-250. Acknowledgments: NONE Return To The Case Studies List.		Back
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