Heel Pain-Basketball

Abstract

1050 HISTORY: A 10 year old female basketball player presents with right heel pain that began 9 months ago when she stepped on a pebble playing basketball barefoot. It bothers her with prolonged walking or after 5 minutes of running. She limps after running. Pain is present first thing in the morning but does not awaken her at night. She has no left heel complaints. She has been taking 800 mg of Advil before practices and games with no relief. An earlier evaluation had found normal calf flexibility and the recommended viscoelastic heel pads improved symptoms somewhat. PHYSICAL EXAMINATION: She walks with an antalgic gait. Her right heel is broadened compared with her left heel. She has slight right calf atrophy and mild heel cord contractures with only a few degrees of dorsiflexion noted bilaterally. No ankle effusion is present. She has a cavus foot type with normal ankle and subtalar motion. There is tenderness about the entire posterior calcaneus. Her skin is normal in appearance and distal sensation and circulation are intact. DIFFERENTIAL DIAGNOSIS: Neoplasm/lipoma/cyst Calcaneal apophysitis Calcaneal fracture Retained foreign body Puncture wound with low grade infection TEST AND RESULTS: Lateral and axial views right heel Calcaneal apophysis widened at the lateral and proximal aspects Apophysis slipped superiorly and laterally Comparison left heel views Normal appearance FINAL/WORKING DIAGNOSIS: Slipped right calcaneal apophysis TREATMENT AND OUTCOMES: Pneumatic Air Cast walking boot with viscoelastic heel insert. Secondary to continued pain in boot, crutches used and weight bearing as tolerated. No sports or gym class Aggressive stretching, stationary bike, therapeutic strengthening exercises stared after 3 weeks. Gait retraining to stop her from coming down hard on heel strike. Weaned out of boot while indoors to sneakers, Air Cast stirrup and silicone heel pad after 1 month. Still using boot for outside activities. Participated with medical limitations in National Basketball championship after 7 weeks. Wore lateral stabilizing brace secondary to continued peroneal weakness. Family moved to Houston and transferred care at 10 weeks. Long-term follow-up 2 years later, no further symptoms. Still growing and still playing highly competitive basketball.