Corey Richards A384 Case Study Background: On January 9, 2013, a 22 year old male sprinter on the Indiana University

Track and Field team complained of anteromedial right foot pain. He admits hes noticed the pain for a few months but it has gotten progressively worse the past week. Push off causes the most pain and there is occasional focal swelling. Pain is apparent when in sprint spikes and especially during sprinting activities when he is up on his toes. Evaluation revealed extensor tendonitis of his great toe. During the assessment, the patient had pain on the dorsal aspect of the extensor hallucis longus tendon on the midshaft of the first metatarsal. The patient experienced pain during the break test of the great toe extensor as well as during graded manual muscle testing of the same muscle. Tap test, percussion test, and tuning fork were all negative. Patient has no prior history of a foot injury. Differential Diagnosis: Posterior tibialis strain, extensor hallucis longus strain, extensor digitorum tendinitis, deltoid ligament sprain, plantar fasciitis, navicular stress fracture. Treatment: The Patient met with the team physician on January 15, 2013 when he was referred for an X-ray. The patients x-ray was essentially normal. After a week of rehabilitation, the patient showed no signs of improvement and was seen by a foot specialist and a CT scan and MRI were ordered. The patient was diagnosed with a navicular stress fracture, as revealed by the CT scan, that will require surgery. During the acute phase of rehabilitation, therapeutic goals will include regaining 50% range of motion, decreasing swelling (22.5 in. girth to 21 in. girth), and decreasing pain (4/10 on pain scale). Thus the patient began cryotherapy and range of motion (ROM) exercises to meet acute rehabilitation goals. During the sub-acute phase of rehabilitation we will increase range of motion using manual therapy, strengthen the ankle, foot muscles and ligaments with calf raises and slide board exercises, decrease inflammation and swelling with ultrasound and ice cup, and begin balance and proprioceptive exercises. During the chronic phase of rehabilitation we will increase strength and proprioception and maintain cardiovascular fitness through pool workouts, biking, and using the stairmaster. Sport specific exercises will be started to ease back for return to play. Uniqueness: This particular case is unique because the initial diagnosis was incorrect. After about 2 weeks of rehabilitation the patient was not improving so additional testing took place and diagnostic imaging proved there was a more severe injury. Secondary evaluations and physician follow-ups proved to be a very important aspect the rehabilitation exercises failed. Conclusion: Navicular stress fractures differ patient to patient depending on the severity of the fracture and direction at which it fractures. Surgical intervention isnt the only treatment option. Often times a navicular stress fracture of less severity will be treated without surgery. Athletic trainers should know that when dealing with this type of injury they have treatment options. Team physicians have many factors to take into consideration before making an operative or non-operative decision. Regardless of treatment option utilized, navicular stress fractures are very debilitating but with a disciplined clinician and a compliant patient, the route to recovery is most efficient.