Foot Pain in a Cross Country Runner Nicole Huntress M.D. Primary Care Sports Medicine Fellow Steadman Hawkins Clinic of the Carolinas SEACSM Conference.

Slides:



Advertisements
Similar presentations
(Facility Name Here) (Physicians Name Here) (Practice Name Here) (Practice Address Here) (Practice Phone Number Here) (Practice Website Here)
Advertisements

Common Pediatric Foot Deformities Affiliated Foot & Ankle Center, LLP
Foot, Ankle, Lower Leg Injuries
Lower Limb Problems Orthopaedic Medicine.
Southeast ACSM Conference February 5, 2011 Mandy Huggins, MD Emory Sports Medicine Center.
Common Running Injuries
HARMELING PHYSICAL THERAPY
Doc,I cant walk now! Rick Horak, MD Primary Care Sports Medicine Fellow ASMI SEACSM 11 Feb 2012.
Midfoot Fractures Jenny Jefferis.
Ankle Sprain Imitators
Chapter 19: The Ankle and Lower Leg
The Shins: Shin Splints and Fractures James DuRant – Radiology Elective – October 22, 2009 University of South Carolina School of Medicine.
Great Toe Pain: An Unexpected Finding Kennieth McCollough, MD American Sports Medicine Institute SEACSM February 10, 2012.
Plantar Fasciitis Dick Evans PT,OCS.
EXAMINATION OF THE FOOT AND ANKLE Dr. Mohammed Zaheer Dalati Senior Registrar Department of Orthopaedics College of Medicine King Khalid University Hospital.
Heel Pain Dr. Dennis R. Frisch 30 SE 7 th Street Boca Raton, FL
Anatomy of The Foot & Ankle
© 2010 Delmar, Cengage Learning 1 © 2011 Delmar, Cengage Learning PowerPoint Presentation to Accompany.
The ANKLE and the FOOT TRAUMA MI Zucker, MD.
The Lower Leg. ANATOMY  Bones  Tibia  Fibula MUSCLES  The muscles are in four compartments with 2-4 muscles in each compartment  Compartments are.
How Can You Find Relief? Common Foot and Ankle Conditions:
Correlating Clinical and MRI Scan Findings in Low Back Pain Jim Messerly D.O.
Clinical Assessment of Foot & Toe Injuries Part II
Plantar Fasciitis Dick Evans PT,OCS. Plantar Fascia Thick broad connective tissue that spans the arch of the foot Originates on the medial tubercle of.
Patellofemoral Pain. Objectives 1.Understand the anatomy of the patellofemoral joint 2.Learn 3 causes of PFPS 3.Understand the muscular imbalances that.
Common Pediatric Orthopaedic Problems
Ankle Anatomy Review Mr. Brewer. Terminology Distal – Further away from the core of the body. Proximal – Closer to the core of the body. Lateral- Away.
LOWER LEG, FOOT & ANKLE ANATOMY, RECOGNITION, TREATMENT, THERAPY TIM AMSHOFF LAT MOORE TRADITIONAL SCHOOL.
The Meniscus. Anatomy Lies between the femur and the tibia Two menisci: lateral and medial Avascular- doesn’t have blood vessels inside (prevents it from.
Chapter 8: The Biomechanics of the Upper Extremities
Lower Body Evaluation ATC 328 The Foot and Toes Chapter 4.
Ms. Bowman. 26 bones Phalanges-toes; proximal, middle, and distal Metatarsals-5; between phalanges and tarsals Tarsals-calcaneus, talus, navicular, cuboid,
Jacobi Ambulatory Care Service Low Back Pain Intern Ambulatory Block Susan Dresdner, M.D.
Athletic Injuries ATC 222 Foot, Ankle, and Leg Chapters 14 and 15.
Chapter 4 The Foot and Toes continued. Range of Motion Testing  Focus on MTP joints (flexion & extension)  Bilateral comparison  Box 4-4 Foot Goniometry,
Ch. 17 Foot, Ankle, and Lower Leg
Imaging studies of Lower limb Dr. Abubakr H. Mossa
Orthotic evaluation: Dynamic evaluation: internal tibial rotation most signifigant. Palpatory exam of foot and ankle: Pain on navicular, lateral talus,
Ankle and foot Saggital slice mri.
THE FOOT Chapter 18.
The Ankle & Lower Leg  Bones:  Tibia (Medial Malleolus)  Fibula (Lateral Malleolus)  TalusCalcaneus (Heel Bone)  Ankle Ligaments (Lateral & Medial)
Acute Posterior Ankle Pain in a High School Football Player John Hardin, MA, CSCS, ATC.
The Whole is more than the sum of the parts
Athletic injuries 7th Grade Health.
Treating Foot, Ankle, and Lower Leg injuries Sports Medicine 2.
19-1 Kinesiology for Manual Therapies Chapter 19 The Ankle and Foot Joints McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved.
KAYLA CUNNINGHAM Medial Tibial Stress Syndrome. The Patient 20 year old, female College basketball player Began to feel severe discomfort on the medial.
RUNNING MEDICINE Common injuries and causes, core strength evaluation and treatment options Daniel Day, DO Sports Medicine Physician Western New York Sports.
Exercise Injuries to the Foot & Ankle. Where Do These Injuries Occur?  Toes  Forefoot (front of the foot)  Midfoot (middle of the foot)  Hindfoot.
Injuries to the Lower Leg, Ankle, and Foot. Anatomy  Provide stable base of support and a dynamic system for movement  Bones of the lower leg consist.
Foot, Ankle, Lower Leg Injuries Sports Medicine 1 Enterprise High School W. Brack.
Lower Leg/Ankle Injuries. Great Toe Sprain Aka – turf toe MOI ▫Excessive force applied to great toe (flexion or extension)  Force causes sprain/strain.
Peroneal Tendinosis BY: NEIDA MONTESINO. What is Peroneal Tendinosis? ​ The peroneal tendons run on the outside of the ankle just behind the bone called.
Foot & Ankle Injuries in the Workplace. Types of Workplace Injuries  Acute  Chronic  Develops over time  Falling items  Tripping/falling.
Chapter 8: The Foot. The Foot The two primary roles of the foot are propulsion and support 80% of the population has some form of foot issue 26 bones.
Injuries to the Lower Leg, Ankle, and Foot. Anatomy  Provide stable base of support and a dynamic system for movement  Bones of the lower leg consist.
Basic Athletic Training Chapter 6 Foot, Ankle, and Lower Leg
EXAMINATION OF THE FOOT AND ANKLE
Signs & Symptoms Treatment & Rehab
Unit 5:Understanding Athletic-Related Injuries to the Lower Extremity
Common Foot Injuries Among Runners
Accessory Navicular Syndrome
By: Nubia Dickinson, Destiny Atiles and Tonyque Davis
Lower Leg.
Foot and Ankle Injuries
Flatfoot in Adults.
Iliotibial Band Friction Syndrome (ITBS)
Signs & Symptoms Treatment & Rehab
Injuries to the Pelvic Region & Lower Extremity
Presentation transcript:

Foot Pain in a Cross Country Runner Nicole Huntress M.D. Primary Care Sports Medicine Fellow Steadman Hawkins Clinic of the Carolinas SEACSM Conference February 10, 2012

HPI  13yo female c bilateral foot pain >1 year  Worst on inside of L foot  Activity related  No systemic symptoms

PE  Inspection: nl arches, prominent L navicular, no swelling/ecchymosis/erythema  TTP L posterior tibialis tendon and navicular  FROM, ankle stable  Strength: resisted inversion painful on L, weak core c single leg stance, squat, hip adduction  Flexibility: bilateral tight heel cords and hamstrings, R hip flexors and quadriceps  Negative tinels

X-RAYS  Weight bearing bilateral AP, lateral, oblique views  Accessory navicular on L, open physes, no fracture or other bony abnormality

Differential Diagnosis  Symptomatic accessory navicular  Stress fracture/reaction  Tendinopathy  Other neurologic etiology

Initial Treatment  Orthotic shoe insert  Physical Therapy  Activity as tolerated, ice afterward

Follow-up  Initial improvement  Worsened with cross country onset  MRI of L foot  extensive patchy marrow edema of tarsal bones, accessory navicular

Follow-up  No interval change  Short walking boot L  Labs  Normal: CBC, CMP, Mg, Phos, ESR, CRP, Ferritin, Iron, TIBC, Reticulocyte, TSH  Vitamin D low at 29.8  Dexa Scan  lower limits of normal, to 0.957gm/cm3, z-score -0.6 to -0.9  Nutritionist referral  MRI R foot  Numerous foci of increased marrow signal of hindfoot and midfoot, no accessory navicular

Conclusions  13yo female cross country runner with painful Bone Marrow Edema Syndrome  short L cast and R boot  Now wearing custom orthotics  Ongoing bilateral mid-foot pain  Endocrine consult pending

Thank you QUESTIONS?

A ‘normal’ finding? Shabshin, Schweitzer, Morrison, Carrino, Keller, Grissom. High Signal T2 changes of bone marrow of the foot and ankle in children: red marrow or traumatic changes? Pediatric Radiology  402 bones in 41 pediatric (1-18yo) patients  BM changes on T2 MRI in 11% overall, 59% <16yo  Calcaneous 54%, talus 35%, navicular 35%  Most bilateral and most resolve by 15yo  Hematopoietic red marrow, physiologic stress, biomechanics?