Imaging Quiz Question
Forefoot Pain in a Young Girl
Kenneth R. Veenema, MD
THE PHYSICIAN AND SPORTSMEDICINE - VOL 27 - NO. 1 - JANUARY 1999
A 12-year-old girl struck her left foot against a wall during a school basketball game but continued to play, despite a minor injury. During the following days, she developed mild forefoot swelling and persistent discomfort in the foot. She presented to her primary care physician, and plain x-rays were unremarkable. She was diagnosed as having a foot sprain and was given no specific treatment.
Her left foot continued to be painful, so she stopped playing basketball, and with several weeks of rest, the pain and swelling improved. However, when she began participating in softball, the pain returned.
She was reevaluated, diagnosed as having a stress fracture, and placed in a short leg cast with weight bearing as tolerated for 6 weeks. After removal of the cast and 3 weeks of subsequent unprotected weight bearing, the pain recurred.
Six months after the initial injury, she presented to a sports medicine clinic with persistent left forefoot pain. Physical examination demonstrated localized tenderness and mild plantar swelling of the left third metatarsophalangeal joint. Drawer testing of the involved joint accentuated the discomfort and was associated with a grinding sensation. The pain worsened during the toe-off phase of walking. Standing forefoot and hindfoot alignment were normal, and skin and neurovascular findings were unremarkable. A rigid cavus longitudinal arch was evident. A plain film obtained at this time is shown in figure 1.
Dr Veenema practices at University Sports Medicine in Rochester, New York, and is an assistant professor of emergency medicine and orthopaedics in the Department of Emergency Medicine and Orthopaedics in the Division of Athletic Medicine at the University of Rochester School of Medicine. Address correspondence to Kenneth R. Veenema, MD, University Sports Medicine, 2180 S Clinton Ave, Rochester, New York 14618.