Acute Foot Injury???Professional Ballet Dancer

Abstract

HISTORY 36 year-old female professional ballet dancer presented with acute onset of proximal plantar foot pain. Prior to injury she had a 3-day history of plantar foot pain with increased symptoms in the morning. She has not had previous treatment or injections. This pain dissipated as morning activities increased. The pain was located in the region of the distal plantar heel. During a routine workout she felt a tear and severe pain as she attempted a jump. After this event, she was unable to continue dancing and had pain with weight bearing and any ankle motion. PHYSICAL EXAMINATION Examination revealed a fullness and tenderness at the proximal insertion of the medial plantar fascia. Range of motion of the ankle was painful and she was unable to bear weight with a single leg stance. There was moderate pain with resisted plantar flexion and pain with forced dorsiflexion. DIFFERENTIAL DIAGNOSIS Plantar fasciitis Acute rupture of plantar fascia Avulsion fracture of the calcaneous TEST AND RESULTS MR imaging: Revealed a complete tear of the medial plantar fascia at its origin from the calcaneous The lateral plantar fascia was edematous without evidence of a tear. FINAL WORKING DIAGNOSIS Acute rupture of the plantar fasciaFigureTREATMENT AND OUTCOMES Non-steroidal anti-inflammatory medications Non-weight bearing for 2 weeks in a removable cast boot Physical Therapy consisting of gentle range of motion, icing and deep massage Protected weight bearing with heel cup for after decrease in pain symptoms Advancement to barre work in high-top shoe after resolution of symptoms, with avoidance of jumping for 2 additional weeks