Foot Pain – College Football Player


B. Tew, K. Vanic, G. Rozea, W. Wheeler-Dietrich, East Stroudsburg University, PA. email: kvanic@esu.edu (Sponsor: K. N. Waninger, FACSM)

HISTORY: A 20-year-old male collegiate DII football player was examined in the locker room at half time after sustaining an injury to his left foot. During pre-game activities, his left foot was stepped on as his foot was planted and slightly rotated. Initially, he underreported his symptoms and was allowed to start the game. During halftime, he described the apparent nature of his injury. Past medical history of left navicular fracture. Idiopathic Toe-walker (ITW).

PHYSICAL EXAMINATION: Pain scale 8/10. Point tenderness was elicited over the navicular, 1st cuneiform, and 1st and 2nd tarsometatarsal joint. Dorsal edema was noted. He appeared neurovascular intact. Initial diagnosis by physician on sidelines was a midfoot sprain. Past medical history of navicular fracture warranted ER follow up post-game. Following Monday, he athlete was provided pain medication and crutches for ambulation with pneumatic walking boot. Full activity restriction warranted.

DIFFERENTIAL DIAGNOSIS: longitudinal stress injuries; fracture base of second metatarsal, cuboid fracture, navicular compression fracture, rupture of posteior tibialis tendon, compartment syndrome TEST AND RESULTS: One week post-injury, stretching/strengthening activities ensued. Athlete could not pass functional tests for return to play. MRI determined that the athlete sustained a grade 3 Lis Franc sprain with a dislocation of the 2nd metatarsal. An avulsion fracture of the base of the 2nd metatarsal was ruled out. Surgery was required.

FINAL/WORKING DIAGNOSIS: Lis Franc Fracture-Dislocation TREATMENT AND OUTCOMES: Open Reduction Internal Fixation (ORIF) was performed on the medial aspect of the foot by the 1st cuneiform; 1st cuneiform was fixated to the 2nd metatarsal and the middle cuneiform. Post-surgical treatment involved placing the patient in a walking boot and crutch ambulation for 2 weeks. After this time, the athlete was allowed to fully weight-bear. Over the next two months, athlete had a subsequent surgery to remove the hardware. After this surgery, he was required to use the walking boot for 2 weeks, and afterwards was allowed to return to full weightbearing status and cleared for activity. Orthopedic surgeon did not require rehabilitation post-operatively. The athlete has since returned to full-activity but is having complications due to excessive scar tissue and tendonitis of the extensor hallux longus. Post-operative complication may have been avoided with compliant rehabilitation efforts.

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