ANKLE PAIN - BASKETBALL 1053

Abstract

HISTORY - A 12-year-old white female basketball player presented for evaluation of left ankle pain which had been present for approximately 2 years. The patient and her mother recalled symptoms dating back to the fifth grade. She recently participated in a basketball camp and developed a recurrence of left ankle pain. She was diagnosed with Sever's disease and was treated with a heel cup. Left ankle pain continued despite this treatment. She stated the pain was mostly on the inside of her left ankle. She reported no history of trauma to her left ankle. Pain was present with running and was relieved with rest. The patient further denied swelling, catching, or locking symptoms. PHYSICAL EXAMINATION - The left ankle was free of swelling or ecchymosis. There was tenderness over the medial aspect of the left ankle in the vicinity of the sinus tarsi. There was no tenderness directly over the medial or lateral malleoli. Full range of motion with dorsiflexion/plantarflexion and eversion/inversion without discomfort. There was some medial pain with resisted internal rotation. Anterior drawer revealed no laxity. Talar tilt was negative. Neurovascular exam was normal. DIFFERENTIAL DIAGNOSIS: Left ankle sprain (deltoid ligament) Sinus tarsi syndrome Syndesmosis sprain JRA Epiphyseal injury Stress fracture TEST AND RESULTS: X-ray: Plain film x-ray revealed lytic lesion involving medial aspect of left talus MRI: Revealed a confirmed osteochondritis dissecans, left posteromedial talus, and indicated that the fragment was nondisplaced FINAL/WORKING DIAGNOSIS: Osteochondritis dissecans of the left posteromedial talus, Stage II TREATMENT: Short leg walking cast to the left lower extremity for 6 weeks. After 6 weeks, the cast was removed. Follow-up x-rays were taken, revealing a well-healed posteromedial aspect, left talus. The patient was started in physical therapy to increase ankle strength and range of motion. She was also started on the BAPS board to increase proprioception. The patient will be followed to monitor progress.