Foot Pain In A College Soccer Player

HISTORY: A 22-year-old college soccer player presented to the training room the day after injuring his left foot in a match. He jumped for a header and when he landed another player stepped on the outside of his left foot. He was evaluated on the field by training staff and felt he was able to continue and was able to finish the match. Lateral foot was painful and swollen and having difficulty bearing weight on the foot. He has not had any prior injury to this foot. PHYISCAL EXAMINATION: Left foot reveals swelling around the lateral aspect of the foot without ecchymosis. Tenderness to palpation over the base of the fifth metatarsal. Full and symmetric range of motion of the ankle with strength 5/5 in all ranges motion against resistance. No sensory changes. DIFFERENTIAL DIAGNOSIS: Jones fracturePseudoJones fractureDancer’s fractureContusion TEST AND RESULTS: AP, oblique, and lateral radiographs of the left foot obtained. Radiographs demonstrated linear lucency at the base of the fifth metatarsal, subacute/chronic in appearance. No prior radiographs available for comparison. FINAL/WORKING DIAGNOSIS: Symptomatic Os Vesalianum Pedis TREATMENT AND OUTCOMES: Without prior films available and inability to obtain contralateral films same day in training room, it was difficult to differentiate between symptomatic os vesalianum pedis versus avulsion fracture of the base of the fifth metatarsal, although radiographic features favored the former. The athlete was initially placed in a tall walking boot and crutches and after one week demonstrated significant improvement and was ambulatory without difficulty. The team was towards the end of their season and he desired a quick return to play and decision was made to perform injection of triamcinolone acetonide and ketorolac into the pseudo joint. He was able to return to sport a couple days after the injection and successfully complete the season without further exacerbation.