Working Diagnosis:
Metabolically active right Myositis Ossificans
Treatment:
A bone scan was performed to determine if the heterotopic ossification in her calf continued to be metabolically active or was a mature bony lesion. Bone scan demonstrated that the ossification continued to be metabolically active two years after the initial injury.
The typical conservative treatment regimen was initiated, consisting of ice, NSAIDs, PT, stretching and strengthening exercises, and compression with a neoprene calf sleeve. Given the metabolic activity of the ossification, surgical resection of the lesion was not recommended at this time.
Outcome:
At the three month follow up she continues to have pain after prolonged walking and jogging on the treadmill but is able to tolerate the stationary bike. She has been noncompliant with PT, stretching and strengthening and inconsistent NSAID use. She was re-referred for more formal physical therapy. If pain and loss of motion continue, a repeat bone scan will be considered in 6-12 months to reexamine the metabolic activity of the lesion.
At her next visit she had improved compliance with her physical therapy regimen.
Improvements:
Reduced overall pain
Improved gait with walking and running
Improved ankle dorsiflexion
Increased hip/ankle strength
Works in Progress:
Limited ankle flexibility
Decreased ankle stability and motor control
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