DD has injured her drag foot again.

[thefinest]

My DD broke her foot last varsity season pitching. She's not sure exactly when it happened but it just got worse and worse. Finally, I took her to the Dr. and her ligament had pulled a piece of bone off the top of her foot. She apparently drags her foot too hard. She ended up being put in a boot and missed pretty much her whole travel season.

She just pitched tonight for her school fall ball team and says she feels the pain again in the same place. I'm going to get her into the Dr ASAP of course but am wondering about the long term effects of this on her pitching career.

Not sure if we need to completely change her pitching motion or what to do...obviously she has to do something different or she will no longer be able to pitch. She goes to BH by the way and last time we saw him he suggested really kicking out the front knee. Not sure if she's going to be able to do that or if we just need to figure out a different way for her to drag her foot. He also said he had never heard of this happening so it must be a pretty rare thing.

 

[javasource]

Ligament issues typically have a high recurrence factor. I'd take PT to a whole new level with this kid... lots of ankle proprioception routines... wobble boards, stability pillows, etc. I'd also be curious as to what ligament this is.. Was it the ATF ligament? Ankle injuries alter sensation and muscle function... make sure that ankle proprioception is fully restored. Does she wear a brace?

 

[thefinest]

Ligament issues typically have a high recurrence factor. I'd take PT to a whole new level with this kid... lots of ankle proprioception routines... wobble boards, stability pillows, etc. I'd also be curious as to what ligament this is.. Was it the ATF ligament? Ankle injuries alter sensation and muscle function... make sure that ankle proprioception is fully restored. Does she wear a brace?

Thanks for your help java! I can't remember which ligament it was. I'll find out at the dr. I know its on top interior of her foot where her ankle and foot meet. It feels more like ankle pain then foot pain. She doesn't wear a brace.

 

[thefinest]

I looked up her paperwork and it was a Navicular avulsion fracture. Not sure which ligaments were involved but that probably gives you an idea. I made her an appt for tomorrow afternoon. Really hoping she doesn't have to miss another whole season of softball. So frustrating!

Any ideas on how to change up her footwork to eliminate this happening again? Does she seem to drag hard? I don't know why the video is so blurry. It's crystal clear on my iPhone..maybe I'm doing something wrong with the upload?

 

[javasource]

Not a doctor... however I am quite familiar with this TYPE of injury. In our mind, we want to turn our attention towards "what can she do"... which we should do... but it might be a better use of time to make sure the medical professionals completely eliminate abnormalities. Example... I went to school with a kid that was a killer basketball player. He had this fracture a couple times. He did whatever he could to prevent it... but the underlying cause that was discovered later was that he actually had one leg longer than the other. Once he got the lift he needed... he was like a new dude. I've seen something similar in two girls... one that ran track and played travel, and another one that was "all heals"... you could hear her coming down a hallway from a mile away.

If I recall... younger female athletes are more prone to this. Foot patterns that are a little off get exacerbated by poor knee and trunk proprioception... as it is beyond proven that growing women have a significantly greater challenge at this than guys. That area... I think they call it the N spot... or something like that... deals a lot with pushing mechanics... it bears a lot of load. She could just have a sprain this time around... which is very, very common.

No matter the case here... imagine trying to run better when your quasimodo. You can practice a new gait a million times... but if you don't tackle the underlying issue... posture... your gait will never really change. Whereas if you took quasi to a rolfer... got that dude aligned better... then voila... your gait automatically changes.

Look for things like shoe wear patterns, abnormal heal strikes, valgus of the knee, trunk proprioception... and have a specialist look at her gait patterns... namely with her dominant foot. You'll also want to take a look at other sports she might play... anything that involves a lot of running and jumping might need to be addressed, too. You'll want to make sure this kid takes a good chunk of time warming-up... or slowly transitioning between sports.

Sucks that you guys are going through this... but the understanding she'll gain of her body and what it needs will go a long way for her. If it's not too much to ask... I hope you post the results... and know that we are all pulling for her here at DFP!

 

[MandM]

HI! Not a podiatrist or orthopedist but checked to find that there are different types of navicular avulsion fractures- I copied and pasted information here- each of these is caused by a different specific motion of the foot- and while I totally agree with Java that this could be indicative of a larger issue- I think it would be helpful to pinpoint the specific type of motion that has caused the problem to begin with.

"Approximately 50% of navicular fractures are avulsion fractures. These low-energy injuries result from disruption of the (1) dorsal talonavicular ligament, (2) anterior division of the deltoid ligament, or (3) traction of the posterior tibial tendon or spring ligament complex. Avulsion of the talonavicular ligament occurs in extreme inversion and plantarflexion, while deltoid ligament failure is seen with extreme eversion. Tuberosity avulsions are the result of an acute eversion or valgus injury to the forefoot."

My guess is that for your DD it may be the (1) type injury as your MD indicated that the injury was to the "top of the foot"- especially if she drags right over the top of her foot but I think it would be helpful to be certain of the location and the motion that caused it.

COuld you get a better image of your DD? wi/close up of the drag foot?

PS this is reference- Acute fractures of the Tarsal Navicular. in Orthopedics. 2014 Aug;37(8):541-6. I can send but think it will be TMI.

 

[thefinest]

Thanks guys for your help! Java, what kind of dr/specialist would that be that would look at all that for her? Would be awesome if it was just an easy fix and she didn't have to figure out a new way of pitching! I'm praying it is just a sprain! She has her appt at 3:30 today and I will definitely report back.
MandM, I finally found a video that isn't uploading all blurry!

 

[MandM]

I think after watching- it is important to know if it is plantar flexion that caused the problem (google image plantar flexion injury and you can see how it could have happened) or eversion (check those pictures too)- My guess after watching is that it is the latter.

 

[thefinest]

Back from the Dr. It was a different Dr. from the one she had before. He says that he thinks her ATF is loose. He checked both feet and said that her drag foot is much looser than the left foot. He said that the Navicular bone looked ok. DD is a little wary though because before he came into the room she was able to find a tender spot on the top of her foot but when he was checking he never found it. She's just worried because it feels the same way as it did before with the fracture.

He gave her an air cast ankle brace to wear during activities, told her to ice it after activities, and told her to take ibuprofen. He also said that she may eventually need surgery on it.

Not sure what to do from here. I think pitching has caused this ATF to be loose and am not sure how to go about getting her to not drag so hard. I did show him the video of her pitching and he seemed to think that it could be either motion, MandM. He didn't specify.