Author: Adam Fletcher, MD
Co Author #1: Siobhan Statuta, MD
Editor: Melissa Nayak, MD
Senior Editor: Margaret E Gibson, MD
An 18 year old female softball pitcher developed right ankle pain which did not respond to conservative management. MRI revealed calcaneonavicular coalition, and she subsequently underwent coalition resection. She was healing well at the 6 week visit and began rehabilitation. At three months, while stretching with a trainer, she developed rigidity and twitching in her right 2nd through 5th toes. Two weeks later, she presented to the athletic training room with 10/10 burning pain throughout the lateral-dorsal foot with persistent, involuntary toe movement.
Well-healed scar over the dorsum of the right foot without additional skin changes, swelling, or temperature asymmetry. Strength is 5/5 throughout. Muscle bulk and tone are normal. Reflexes are symmetric and normal. Right 2nd through 5th toes have a lateral circular toe movement at 2-3 hertz that is not rhythmic but constant, with sitting, supine, standing, and walking. Hyperalgesia of the lateral-dorsal region of the right foot. Gait is antalgic due to pain and remarkable for the toe movements.
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