Presentation on theme: "Foot Pain in a Cross Country Runner Nicole Huntress M.D. Primary Care Sports Medicine Fellow Steadman Hawkins Clinic of the Carolinas SEACSM Conference."— Presentation transcript:
Foot Pain in a Cross Country Runner Nicole Huntress M.D. Primary Care Sports Medicine Fellow Steadman Hawkins Clinic of the Carolinas SEACSM Conference February 10, 2012
HPI 13yo female c bilateral foot pain >1 year Worst on inside of L foot Activity related No systemic symptoms
PE Inspection: nl arches, prominent L navicular, no swelling/ecchymosis/erythema TTP L posterior tibialis tendon and navicular FROM, ankle stable Strength: resisted inversion painful on L, weak core c single leg stance, squat, hip adduction Flexibility: bilateral tight heel cords and hamstrings, R hip flexors and quadriceps Negative tinels
X-RAYS Weight bearing bilateral AP, lateral, oblique views Accessory navicular on L, open physes, no fracture or other bony abnormality
Follow-up Initial improvement Worsened with cross country onset MRI of L foot extensive patchy marrow edema of tarsal bones, accessory navicular
Follow-up No interval change Short walking boot L Labs Normal: CBC, CMP, Mg, Phos, ESR, CRP, Ferritin, Iron, TIBC, Reticulocyte, TSH Vitamin D low at 29.8 Dexa Scan lower limits of normal, to 0.957gm/cm3, z-score -0.6 to -0.9 Nutritionist referral MRI R foot Numerous foci of increased marrow signal of hindfoot and midfoot, no accessory navicular
Conclusions 13yo female cross country runner with painful Bone Marrow Edema Syndrome short L cast and R boot Now wearing custom orthotics Ongoing bilateral mid-foot pain Endocrine consult pending
Thank you QUESTIONS?
A ‘normal’ finding? Shabshin, Schweitzer, Morrison, Carrino, Keller, Grissom. High Signal T2 changes of bone marrow of the foot and ankle in children: red marrow or traumatic changes? Pediatric Radiology 402 bones in 41 pediatric (1-18yo) patients BM changes on T2 MRI in 11% overall, 59% <16yo Calcaneous 54%, talus 35%, navicular 35% Most bilateral and most resolve by 15yo Hematopoietic red marrow, physiologic stress, biomechanics?