A 35 year old marathon runner comes to you because of foot pain. The pain is mostly in the medial arch of her foot. There is point tenderness over a bony prominence inferior and anterior to the medial malleolus. Imaging is shown above.
Challenge: What's your diagnosis?
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2 comments:
seems like a Taesal Navicular Fracture... (avulsion fracture.)
this here presents like a stress fracture due to the race and training. it can be cause by the continious tear of the M. tibialis posterior or due to ligaments (lig deltoides ) on the tuberosity of the navicular bone
a different idea would be a tendinitis of the M tibialis posterior... but this wouldnt have a clear fracture on the X ray
a different way to break the navicular bone is with exeessive axial load...especially when running on hard surfaces
there is quite a risk for non union and avascular necrosis (AVN)
its nice to see some more ortho.. i am currently in anesthesia...
great discussion!
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Marathon
This is a navicular stress fracture.
Source: UpToDate.
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