Left Foot Injury In A Female Gymnast

Abstract

HISTORY: A 17-year-old female high level gymnast presented for evaluation of left heel pain and ecchymosis. Two days prior to her presentation, she was sprinting in preparation for a roundoff prior to vault take-off and felt her heel shift when she went to push-off. She fell and was immediately unable to bear weight secondary to heel pain. Pain was exacerbated by any weight-bearing activity and improved with rest. She had been wearing a walking boot and using crutches for ambulation. PHYSICAL EXAMINATION: Healthy-appearing female with a muscular build in no apparent distress. Antalgic gait favoring left foot, avoiding pressure on heel. Ecchymosis along both the medial and lateral aspects of the calcaneus. Tenderness to palpation and associated swelling at the plantar aspect of the calcaneus and along the subtalar joint. Ankle range of motion was full and pain-free. Pain with resisted eversion. Talar tilt and calcaneal squeeze tests were positive. No pain with plantar fascia stretching or palpation along the mid to distal plantar fascia. Achilles tendon was intact. Anterior drawer was negative. Strength was full and light touch sensation was intact. DIFFERENTIAL DIAGNOSIS: 1. Calcaneal stress fracture 2. Subtalar joint subluxation 3. Plantar fascia tear TEST AND RESULTS: Left ankle and foot radiographs were negative for acute fracture or dislocation. Left ankle MRI revealed a focal tear involving the lateral margin of the lateral cord of the plantar aponeurosis. FINAL WORKING DIAGNOSIS: Lateral cord plantar fascia rupture TREATMENT AND OUTCOMES: 1. Walking boot for 6 weeks with gradual wean out of boot during the 6th week and ankle range of motion exercises when out of the boot. 2. Once out of boot, supportive shoes with ankle brace and dorsiflexion night splint at night. 3. Physical therapy focusing on Achilles stretching, ankle range of motion and strengthening until pain and tenderness resolved. Slowly advanced to more sports-specific tasks once pain-free. 4. At 10 weeks post injury, she was pain free while performing plyometric and balance/proprioceptive exercises and had a normal exam with full pain-free range of motion. 5. Functional return to sport given her normal exam and pain-free activity with physical therapy.