Twenty-one Year-old Male Football Defensive Lineman With Right Dorsal Midfoot Pain - Page #1

Author: Brett Martindale, MD
Co Author #1: Stephen Scharmann, MD

Patient Presentation:
A 21 year old male football defensive lineman presented with on-going right dorsal midfoot pain.

The patient first developed vague right midfoot pain during spring football practice. He was treated conservatively by the training staff with a walking boot, and his pain resolved over the summer. When the pain recurred during pre-season practice, a podiatrist found only tenderness in the talo-navicular and 3rd and 4th tarsal-metatarsal joints. He had negative plain films at that time and was diagnosed with capsulitis and received corticosteroid injections into both joints. This relieved his pain. One week later, he came to the sports medicine clinic after feeling a painful pop in the midfoot while pushing off. His exam was nonspecific with tenderness diffusely over the dorsal midfoot. Radiographs were again negative. He was treated with ibuprofen and ice. Prior to the seasonís first game one week later, he received another steroid injection by a team physician. He was able to play initially without pain, but it recurred following the game. He presented to the sports clinic 5 days later, ambulating, but again complaining of continued pain across the dorsal midfoot.

Physical Exam:
During that exam, he had tenderness to palpation at the dorsal talo-navicular joint and pain with passive midfoot supination, resisted plantar flexion and axial load to the 1st metacarpal.
He had full range of motion, no swelling or bruising, negative anterior drawer and talar tilt of the ankle, and his neurovascular 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