Foot Injury in a Recreational Runner

Abstract

Foot Injury in a Recreational Runner Ashkan Alkhamisi, MD, Glenn G. Shi, MD, and George G.A. Pujalte, MD, FACSM HISTORY: A 37-year-old, healthy, young female presented with 5 weeks of left foot pain. She denied any major trauma or precipitating event, but did recall doing holiday shopping for 10 hours straight a few days prior to experiencing symptoms. Patient stated that she used to wear heels all the time at work as a school-teacher. She reported numbness and tenderness over the plantar aspect of the first metatarsophalangeal joint. She wore a metatarsal pad and took ibuprofen with no relief of symptoms. The pain was exacerbated with weightbearing. PHYSICAL EXAMINATION: Left foot: No tenderness to palpation of the hindfoot or midfoot. Pain was elicited with passive dorsiflexion and plantarflexion of first metatarsophalangeal (MTP) joint. Tenderness to palpation along the lateral aspect of the first MTP joint, with no erythema or swelling. Sensation was intact. DIFFERENTIAL DIAGNOSES: 1. Sesamoid osteoarthritis 2. Sesamoid stress fracture 3. Sesamoid dislocation 4. Sesamoiditis TEST AND RESULTS: Left foot, standing, 3 views: Fragmentation of the left lateral hallux sesamoid, with small surrounding foci of mineralization. Remainder of osseous structures were intact. No focal soft tissue swelling. FINAL DIAGNOSIS: Left lateral (fibular-sided) non-union sesamoid fracture TREATMENTS AND OUTCOMES: 1. Immobilization within a boot, with non-weightbearing status for 6 weeks 2. At 2 months post-injury, she continued to have pain and wanted to wear the walking boot for another 1-2 months 3. Repeat radiographs at 3 and 4 months post-injury showed continued non-union of the lateral sesamoid bone. 4. Orthopedic referral was made at 4 months post-injury and she decided to proceed with a left lateral sesamoidectomy with immobilization within a boot for 4 weeks. 5. At 4 months post-operatively, she was able to run with no pain and good range of motion of her left first MTP joint.Figure