Going The Distance: Foot Pain In A Long-distance Runner - Page #1

Author: Deborah Pacik, MD, MPH
Co Author #1: Deborah Pacik, MD, MPH
Co Author #2: Kristina Quirologico, MD
Senior Editor: Rahul Kapur, MD
Editor: Ryan Berns, MD, MPH

Patient Presentation:
The patient was an 18-year old male who presented with right foot and ankle pain that started during his cross-country racing season.

The pain was dull, intermittent, and located on the plantar aspect of his right first metatarsal. Pain was worse with running and standing, and better with rest. The pain had somewhat improved with conservative treatment, including new running shoes, meloxicam, and immobilization in a walking boot for 2-3 weeks, but continued to limit his running and training. The patient was also concerned about the pain interfering with an upcoming hiking trip.

Physical Exam:
On initial exam, the patient had tenderness over the the flexor hallucis brevis (FHB) muscle and the hallux sesamoids of the right foot, the fibular sesamoid being more tender than the right tibial sesamoid. Decreased proprioception with single-leg stance was noted. Double-leg heel raise provoked pain at both right sesamoids. The rest of the physical exam was unremarkable.

Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.

NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.

© The American Medical Society for Sports Medicine
4000 W. 114th Street, Suite 100
Leawood, KS 66211
Phone: 913.327.1415

Website created by the computer geek