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Friday, October 14, 2011

Epiphyseal Injury: Email Followup and Advice

Dr Blake's Note: I had seen Andy with an injury to the growth plate of his 2nd metatarsal head. Andy is a young man with no slow twitch muscles, so very fast, with a gait of running up onto the ball of his feet. His push off with every step placed all his body weight (magnified by his speed and power) onto the injured area. Accommodative padding and advice regarding good vs bad pain was given. The padding was to float the 2nd metatarsal head and place pressure around it. 

Dr. Blake,

I brought my 13-yr-old son (he was 12 at the time of the visit), Andy, in to see you about three weeks ago because he had had pain in the front of his left foot for most of the summer. We had seen another podiatrist, who had advised him not to run or play soccer (his favorite sports) for about 6 weeks. You diagnosed the problem as strain in his epiphyseal plate, because his second toe is longer than his big toe, and since he is a fast runner who runs on the balls of his feet, that second toe was receiving the brunt of the impact on every step forward. You cut out a piece of foam for his shoes with a depression for the second toe to fall into, so that it wouldn't be the first part of the foot to hit the ground. You said he could go back to running/soccer every other day, and also advised that he ice his foot 2x/day.

Here an example of a typically long 2nd metatarsal  compared to the first which at push off will need to take over 100% of body weight.

Here is an example of 2 foot inserts with accommodations cut for the big toe and 5th Metatarsal. Andy need the accommodation to the 2nd metatarsal.

It seems to have worked. Strangely, he had a bit of foot pain in his whole foot for a few days last week (which might have been just one of those transitory pains people get), but that went away. More importantly, the problem in the front of his foot seems to have diminished or at least reduced to a 1 or 2 (maximum), to use the pain scale you described, and seems to only occur in the morning sometimes.

Some questions:
What do you suggest going forward? Resume his full athletic schedule (soccer about 4x/week, running 1-2x/week)?
Dr Blake's comment: Since Andy is not out of pain, increase the workouts next week to 4 days, and if all goes well, 5 days the next week, and 6 days the next week. Since Andy was able to increase activity, the injury is getting less fragile.

Continue icing? Anything else?
Dr Blake's comment: As activity is increased, the pain must stay the same, or diminish. Icing up to 3 times a day is a must, at least twice based on the symptoms.

What about the foam? Continue to use it?
Dr Blake's comment: Yes, some form of accommodation will be important until the growth plate fuses at the age of 14/15.

As his foot grows, I guess we'll have to continue to increase the size of the foam insert? You'd said that human feet stop growing at 14 or 15, if I remember correctly. Does that mean we only have to be concerned about this issue for another year or two?
Dr Blake's comment: Most likely, unless the growth plate has been damaged permanently, but that is very unlikely.

I want to thank you again for the time you took and the concern you showed to make sure that you understood the problem and came up with a solution to the problem. Andy was really unhappy about not being able to do sports. Your efforts made a big difference to him and improved the quality of his life, and we are very grateful.

Take care.

Maury and Andy, You are welcome. Rich Blake

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.