sports medicine clinic. presentation 10 year old lacrosse player presented at clinic with right hind...
TRANSCRIPT
Presentation
• 10 year old lacrosse player
• Presented at clinic with right hind foot pain
• Begin abruptly after lacrosse practice 3 weeks ago
• Pain was diffuse around the heel and present in the region of the right ankle
• Symptoms have increased over the last three weeks
• Worse with weight bearing
DDX of aldoscence heel pain
• Calcaneal apophysitis (severs disease)• Calcaneal stress reaction or stress fx• Retro-calcaneus bursitis• Achilles tendinopathy• Reactive arthritis (Reiter syndrome)• Bone tumor• osteomyeltis
Exam
• NAD• Mild swelling• Moderate tenderness at the lateral ankle• Pain on squeezing the calcaneal • No rubor or calor in the foot or ankle• Capillary refill was normal• No strength or sensory deficits
Medical history
• Soft tissue infection right forefoot after a cut on the chain link fence approximately 2 months before the heel pain
• Rx with oral cephalexin 1 g x 10 days• Complete resolution of activities and was able
to return to full activities within one week of infection
• No chills, fever, or other systemic symptoms
X-rays
• Foot and ankle – mild swelling over the lateral malleolus otherwise normal for her age
• MRI – patchy increase t2 and decrease t1 within the calcaneus
• CT - lytic lesion surrounded by sclerosis in the posterior aspect of the calcaneus
5 weeks after symptoms started
• Low-grade temp and chills
• Clinical exam unchanged
• Higher suspicion of osteomyelitis
Summary
• Non musculoskeletal dx• Atraumatic musculoskeletal symptoms• Osteo can be present without fever or chills• Imaging studies may be misleading• Early dx and tx are keys to successful
outcomes