Pointe Of Contention: A Case Of Foot Pain In A Ballet Dancer

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Pointe Of Contention: A Case Of Foot Pain In A Ballet Dancer - Page #1

Author: Kirra Borrello, BS Co Author #1: Justin Young, MD Co Author #2: M. Kenji Yamazaki, MD Co Author #3: Jennifer King, DO Senior Editor: Justin Mark Young, MD, FAMSSM Editor: Yu-Tsun Cheng, MD Patient Presentation: Chronic foot pain History: A 17-year-old female ballet dancer with past medical history significant for bilateral patellofemoral syndrome presented with chronic right ankle and foot pain for the past three months. She denied any inciting event and described the pain as a 6-7/10 sharp shooting pain that worsened when pointing her foot and was associated with stiffness. The pain was most pronounced at the start of dancing/after breaks and improved after warming up. She also endorsed "clicking" of her medial foot and great toe when plantar flexing. She denied numbness or tingling in the foot or ankle. The pain was significantly impacting her ability to dance, which she was planning to do in college in a few months. Physical Exam: H 5'3", W 117 lbs, BMI 20.6, vital signs within normal limits <br>Musculoskeletal (right ankle/foot): <br>Inspection: Calluses and peeling skin. No swelling, ecchymosis, or erythema. <br>Palpation: Tenderness to palpation of right posterior medial ankle, Achilles tendon, posterior recess, peroneal, and posterior tibialis. <br>Range of motion: Pain at end-range plantarflexion. <br>Strength: 5/5 dorsiflexion, plantarflexion, inversion, and eversion. 4/5 toe flexion. <br>Special tests: Negative Nutcracker sign, Thompson test, ankle anterior drawer, talar tilt, Mulder's maneuver, and plantar fascia stretch maneuver. <br>Neurovascular: Brisk dorsalis pedis and posterior tibialis pulses. Capillary refill < 2 seconds. Normal motor and sensory exam. Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.		Back
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