FOOT INJURY - RUNNING

Abstract

HISTORY - A 23-year-old white male presented with left midfoot pain. He began running five months prior to presentation to help control his weight. He began training with 15 minute runs and worked up to 30 minute runs over one month. He was running 4 to 5 days per week on pavement. He bought new running shoes three months into training and since that time has had left foot pain that he localizes to the dorsal midfoot. The pain initially started after runs and progressed to during and after. The pain prohibits running and is noticeable with walking and at rest. He tried using different shoes, NSAIDS and rest. He was seen by his primary care physician and radiographs were obtained and read as normal. He was then referred to our clinic. There was no previous injury. There is no night pain, fever or chills. PHYSICAL EXAM 5′ 11″ 215 lbs. Neutral knee alignment with mild pes cavus. No gross swelling or ecchymosis. Tenderness localized to base of second metatarsal and middle cuneiform. Full range of motion at talar and subtalar joint. Strength is 5/5 in inversion, eversion, and dorsiflexion. 4/5 plantar flexion strength. Mild discomfort with resisted plantar flexion. Negative anterior drawer. Negative talar tilt. Normal midfoot motion, does not reproduce pain. No tenderness over sesamoids or metatarsal heads. No pain at insertion of plantar fascia or mid calcaneus. Normal pulses. Normal sensation. DIFFERENTIAL DIAGNOSIS Tibialis posterior tendinitis Navicular stress fracture Proximal second metatarsal stress fracture Middle cuneiform stress fracture Lisfranc injury Midfoot sprain Bone Tumor TESTS AND RESULTS Radiographs of the foot - negative for fracture and widening of the Lisfranc joint. MRI of the foot -increased signal on T2 weighted images at the middle cuneiform, distal dorsal aspect, indicating stress fracture. The second metatarsal is normal. FINAL/WORKING DIAGNOSIS Middle cuneiform stress fracture TREATMENT On initial presentation to our office the patient was prescribed cross training including swimming and cycling. At follow up for MRI results he was pain free with ADLs and palpation. Patient was prescribed physical therapy to restore plantar flexor strength. Running was gradually resumed under protocol. Patient remained asymptomatic at three months with full activities.