Foot Pain In A Collegiate Basketball Player

Abstract

HISTORY: A 20 year-old male college basketball player presented to sports medicine clinic with right lateral foot pain for 6 days. Pain occurred while running in a practice basketball game when he felt a “pop” and developed lateral foot swelling with no bruising. He reported minimal discomfort at rest, up to 9/10 sharp pain in right lateral foot with weightbearing. He denied any numbness, tingling, or weakness of right foot. He tried OTC pain medications and icing with no significant pain relief. PHYSICAL EXAM: General: No acute distress. Gait: Antalgic. Right foot: Mild lateral foot swelling with no skin discoloration. Sensation intact to light touch. Tenderness of proximal 5th metatarsal. Normal ROM with ankle dorsiflexion, plantarflexion, inversion, eversion. Normal ROM with 1st great toe dorsiflexion and plantarflexion. Strength 5/5 with ankle dorsiflexion, plantarflexion, inversion, eversion. Pain with resisted eversion. Strength 5/5 with 1st great toe dorsiflexion and plantarflexion. Negative calcaneal squeeze test. DIFFERENTIAL DIAGNOSES 1. Stress fracture (5th metatarsal) 2. Chronic non-union fracture (5th metatarsal) 3. Peroneal brevis tear/tendonitis 4. Apophysitis or ossifying apophysis of the 5th metatarsal base 5. Accessory ossicle (Os perineum) TESTS AND RESULTS: AP, oblique, lateral views of right foot revealed well-corticated zone 1 injury adjacent to the base of the fifth metatarsal. No acute dislocation. No effusion. AP, oblique, lateral comparison views of left foot negative for acute osseous abnormalities. FINAL DIAGNOSIS: Symptomatic Os Vesalianum OUTCOMES: During initial visit, patient placed in tall walking boot with WBAT and refrain from basketball activities. At the 1 month follow-up patient had improving right foot pain and reported compliance with walking boot with ambulation, however repeat radiographs revealed interval displacement of accessory ossicle. Patient agreed to surgical excision of ossicle with peroneus brevis tendon reattachment. RETURN TO ACTIVITY AND FOLLOW UP: Following surgery, patient made NWB in boot for 4 weeks. At 4 weeks post-op, continue NWB in a walking boot and focus on gentle ROM. At 6 weeks post-op, patient WBAT in boot and start PT. At 10 weeks post-op, patient weaned from boot. At 12 weeks post-op, patient pain-free and cleared to return to sport.