Caught On The Wrong Foot: An Unexpected Cause Of Foot Pain In A Football Player

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Caught On The Wrong Foot: An Unexpected Cause Of Foot Pain In A Football Player - Page #1

Author: Tammy Ng, MD Co Author #1: Marcia Faustin, MD Senior Editor: Drew Duerson, MD Editor: Danielle De Freitas, MD Patient Presentation: A 19-year-old male division I collegiate football defensive back presented to clinic for acute-on-chronic right mid-foot pain for 4 days. The pain, which started several months ago, was exacerbated by weight bearing activity and relieved by rest. Four days prior to presentation, patient had an intense workout, after which he started having severe right mid-foot pain and difficulty ambulating. The pain was described as dull, aching, and throbbing. No changes in strength or sensation, and he was able to perform activities of daily living without difficulty. NSAIDs were not helpful, but prior physical therapy was moderately helpful. History: He reported a history of a stress fracture to his right foot during his youth, though he could not recall which bone was involved or when this occurred. Physical Exam: Right foot/ankle: Inspection: Bilateral pes planus. Soft tissue swelling over midfoot with pink discoloration. Palpation: Tenderness over mid-foot lateral tarsals, cuboid, lateral cuneiform, navicular and base of the fifth metatarsal. No tenderness of fibularis tendons, malleoli, or talar dome. Range of motion: 20 degrees at the ankle with dorsiflexion and 35 degrees with plantarflexion. Denied pain with range of motion, but single leg heel raise elicited pain to the lateral tarsals. Had 5/5 muscle strength of his right lower extremity. Evaluation of his left lower extremity otherwise showed no deformities and normal range of motion, stability, and strength. Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.		Back
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