FOOT INJURY - POLE VAULTING 1055

Abstract

HISTORY - A 20-year-old Division 1 pole vaulter suffered medial foot and ankle pain when he landed off of the mat and hit the pole vaulting standard after vaulting 18 feet. He had acute onset of pain with an impact loading to the left medial ankle. Examination at that time revealed ecchymosis and swelling localized about the left medial heel and on the medial aspect of the foot. Plain x-rays at that time were thought to be negative. He was treated for a medial ankle sprain. He attempted to go back and do cross training but had a great deal of difficulty running and had difficulty getting up on his toes. He had continued swelling in the area of the medial heel and midfoot. X-rays of the foot at that time again were negative. At two months the patient was still unable to resume walking activities comfortably. He was unable to participate in any running or sprinting activities and his pain was more localized to the medial midfoot and arch area. PHYSICAL EXAMINATION - Examination 2 months showed residual fullness localized about the midfoot with a normal range of motion of the ankle subtalar midfoot and forefoot. There was good strength throughout the tendinous structures of the foot and pain was localized to the medial midfoot. He was unable to walk on his toes and had pain with single heel raise. DIFFERENTIAL DIAGNOSIS: Medial ankle sprain with deltoid ligament injury Posterior tibial tendon tear Talo-navicular and spring ligament complex injury Lis franc ligament injury TEST AND RESULTS: Standing x-ray examination of left foot: approx 6 mm subluxation of tarsal navicular joint with dorsal subluxation of navicular on talus MRI examination of left foot: diffuse edema pattern with mild flattening and peripheral fractures of minimally subluxed left navicular complete rupture of left spring ligament with anterior deltoid ligament injury. FINAL/WORKING DIAGNOSIS: Spring ligament complete rupture with acquired flat foot and anterior deltoid ligament tear. TREATMENT: 1. Surgical repair of spring and anterior deltoid ligament. 2. 2 weeks - ROM exercises with plantar flexion and inversion. 3. 6 weeks - cast brace, PWB. Progressed to FWB by 8 weeks. 4. 12 weeks - jogging with shoe orthosis. Jumping - 6 months. 6. 9 months - unrestricted activities. Set American record 18 months after surgery. Won USA Olympic trials in 1996.