Puck Shot To Foot Resulting In Pain In Hockey Player

HISTORY: 26 yo M hockey player presents with 3 wk history of left foot pain after puck impact to medial foot while attempting to block a shot. Pain worse when wearing his ice skates tightly laced, has been able to bear weight and continue skating. PHYSICAL EXAMINATION: Left foot with raised prominence over medial navicular bone, symmetric with contralateral side. No swelling or bruising. Tenderness to palpation over the proximal dorsal aspect of the navicular bone. No other bony tenderness. DIFFERENTIAL DIAGNOSIS: 1. Navicular fracture 2. Posterior Tibialis tendonitis 3. Accessory Navicular bone TEST AND RESULTS: Plain films: No cortical irregularities or periosteal reaction. US: Irregularities in dorsal navicular cortex. Tibialis posterior intact with hypoechoic fluid in sheath and neovascularization. CT: Mildly comminuted nondisplaced fracture of the medial navicular bone extending into the proximal and distal articular surfaces. FINAL/WORKING DIAGNOSIS: Mildly comminuted nondisplaced intraarticular fracture of the navicular bone TREATMENT AND OUTCOMES: 1. Initial immobilization plan: non-weight bearing x 4 wks in boot, followed by reimaging, advancing to WB and PT, avoiding impact activity and continue boot for 4 more wks. 2 wk follow up XR with callus over fracture lines of navicular bone, less pain 2. Repeat CT foot at 5 weeks showed interval healing with some callus and no displacement 3. Consult with foot and ankle surgeon after CT, discussed return to play with tape and shot blocker pad. Tolerated without pain. Continued walking boot when off ice for 3 wks with instructions for no impact 4. Pain free at 6 weeks post initial presentation, 9 weeks from original injury. Returned to full activity at 8 wks post presentation