I'm looking for thoughts and input anyone may have on an 18 y.o. field hockey player I saw today. She has a history of bilateral ant-lat. ankle "burning" which comes on within 5 minutes of running. Footwear (sneakers vs. cleats) does not make a difference and running surface does not make a significant difference. This started in the fall of 2008 and only occurs with running.
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She has seen three Orthopedists who have been unable to offer a diagnosis. Xrays and MRI are reportedly normal. She has had two courses of Physical Therapy and an Orthopedist recommended Footmaxx orthotics, none of which has helped her.
She does have some mechanical issues but they are different on the right vs. left yet her symptom is the exact same on the right and left ankles. To simplify my findings for now, I will offer that she is somewhat supinated on the left through stance, has restricted eversion at her left subtalar joint, and decreased mobility at the left calc-cuboid joint. She also has a weak left soleus. She lacks some rotatory control at the left hip as evidenced by the medial deviation of her left knee when running. Her right side is essentially unremarkable yet she has the same symptom. Having very different mechanics right to left but the exact same symptom seems unusual to me if her pain is mechanical (which maybe it isn't?)
Other miscellaneous information-she has bilateral hallux valgus and was born very premature (25 weeks) weighing only a pound and not walking until she was 2 1/2 years old.
No one has been able to help this young woman to date. She is going to College in September and would like to play field hockey or at least be able to participate in intramural sports without pain.
Any ideas are very much appreciated.
Thank you!
Ann
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