Author: Rathna Nuti, MD
Co Author #1: Dr. Robert Dimeff, MD
Editor: Todd May, DO
Senior Editor: Marc P. Hilgers, MD, PHD
16 year old elite gymnast presented with nonspecific right dorsal foot pain for 5 months.
Pain began when she landed on the hard part of the springboard used for vault. Denied hearing or feeling a pop or snap, swelling, discoloration, deformity, paraesthesia, or weakness. She continued participation that day. Later, treated herself with K tape, electrical stimulation, ibuprofen 400 mg BID, ice, analgesic creams, and chiropractic manipulation with some improvement. Running, jumping, and landing worsened pain. Able to perform bars and beam without limitations, but modified vault and floor routines. Since then, developed mild nonspecific left arch pain. History of mild ankle sprains in the past that resolved with rehabilitation and usual conservative treatments.
Takes NSAIDs, MVI, iron, and vitamin D. Denies medical diseases, previous surgeries, and allergies. Besides primary amenorrhea, ROS otherwise unremarkable. FMH noncontributory. Social history: Denies drug/alcohol/substance abuse and history of eating disorder. She trains 30 hours per week and expecting to participate in college gymnastics.
General: Healthy teenage girl, BMI 19, NAD
Lower Extremities: Bilateral hips symmetric, pain-free ROM. No tenderness on palpation. Negative FADIR, FABER. Weakness, no pain, bilaterally with single leg squatting. Knees and ankles FROM, no swelling, tenderness, erythema, warmth, or instability. Right foot FROM, no swelling or discoloration. Mild tenderness on palpation at dorsal side of navicular. No other tenderness. Symmetric strength, no pain with resisted foot or ankle motions. Pulses and sensations intact.
Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.