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- W2617006988 abstract "HISTORY: A 15 year old female high school dancer presented to clinic with recurrent left leg pain in setting of recently treated left fibular stress fracture. She initially presented 6 months prior with focal distal fibular pain. At that time stress fracture diagnosis was confirmed with X-Ray and MRI; imaging revealed incidental left talocalcaneal coalition (TCC). Treatment with walking boot immobilization and activity modification for 6 weeks resolved her pain. She returned to full activities including dance. After 4 months of pain free activity she now presented with left lateral fibular pain more diffuse than prior, worse with weight bearing. She denied trauma, swelling, numbness, tingling, or weakness. Her nutritional status was appropriate. Menstrual cycles were normal since menarche at age 11. PHYSICAL EXAMINATION: Ankle and foot alignment was neutral. She was point tender over several inches of distal left fibula without tenderness of ankle or foot. Left subtalar pronation and supination motion was markedly limited compared to right, but pain free. Ankle strength was full and pain free through available range. Gait was normal. She was neurovascularly intact. DIFFERENTIAL DIAGNOSIS: 1. Recurrent fibular stress fracture 2. Fibular stress syndrome 3. Symptomatic TCC 4. Peroneal tendinopathy TEST AND RESULTS: Left leg MRI, 6 months prior: distal fibular shaft cortical thickening with increased T2 signal of intramedullary canal and periosteum consistent with early stress fracture. Left leg X-Ray, 2 view: cortical thickening of distal fibular diaphysis unchanged from 6 months prior. Left ankle CT: left fibrocartilaginous TCC with cortical irregularity, subchondral sclerosis and cystic changes of middle subtalar facet and adjacent calcaneus surface. FINAL WORKING DIAGNOSIS: Recurrent left fibular stress fracture secondary to impaired subtalar motion from TCC TREATMENT AND OUTCOMES: 1. Walking boot immobilization for 4 weeks to treat stress fracture 2. Orthopedics referral and surgery for left TCC excision with intraoperative normalization of subtalar motion 3. Postoperative short leg immobilization for 10 days 4. Ankle range of motion and strengthening exercises started 2 weeks postoperatively 5. Returned to sport 2 months postoperatively once incision healed and ankle motion/strength appropriate" @default.
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- W2617006988 date "2017-05-01" @default.
- W2617006988 modified "2023-09-27" @default.
- W2617006988 title "Lower Leg Injury-Dance" @default.
- W2617006988 doi "https://doi.org/10.1249/01.mss.0000518381.54031.e1" @default.
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