Stress fractures, particularly those in the lower extremity, are disabling and time-consuming injuries commonly seen in athletes. A stress fracture of the posterior talus is rare and presents with signs and symptoms similar to those of soft-tissue injuries in the rear foot. This case study involves a Division-I collegiate female field-hockey athlete who developed a stress reaction in her posterior talus approximately 6 weeks after sustaining a mild eversion ankle sprain. Her chief complaint was pain with forceful plantar flexion during running and cutting. Clinicians must be cautious when an athlete presents with posterior foot pain, being sure to properly assess and rule out differential diagnoses such as tendinitis, os trigonal fracture, and muscle strains. This athlete was able to remain weight bearing during healing, so her rehabilitation protocol allowed for a variety of exercise options.
Jennifer J. Mancuso, Kevin M. Guskiewicz and Meredith A. Petschauer
Troy Blackburn, Kevin M. Guskiewicz, Meredith A. Petschauer and William E. Prentice
To determine whether proprioception or muscular strength is the dominant factor in balance and joint stability and define what type of ankle rehabilitation is most effective for these purposes.
The University of North Carolina Sports Medicine Research Laboratory.
Thirty-two healthy volunteers free of head injury, dominant leg injury, and vestibular deficits.
Subjects were divided into control, strength-training, proprioceptive-training, and strength-proprioception combination training groups. Balance was assessed before and after 6-week training programs.
Static, semidynamic, and dynamic balance were assessed.
Subjects showed no improvement for static balance but improved significantly for semidynamic (P = .038) and dynamic (P = .002) balance. No significant differences were observed between groups.
Enhancement of proprioception and muscular strength are equally effective in promoting joint stability and balance maintenance. In addition, no 1 type of training program is superior to another for these purposes.
Rebecca L. Dubas, Elizabeth F. Teel, Melissa C. Kay, Eric D. Ryan, Meredith A. Petschauer and Johna K. Register-Mihalik
Context: Currently, there is no gold standard to evaluate the effect of varying game-like exertion states on Sport Concussion Assessment Tool 3rd Edition (SCAT-3) outcomes. Baseline assessments may occur before, during, or after physical activity, while postinjury evaluations predominantly occur following physical activity. Thus, clinicians may be comparing postinjury evaluations completed following exertion to baseline evaluations completed following varying levels of rest or exertion, which may not be a valid method for clinical decision making. Objective: To determine the effect of various physical exertion levels on sideline concussion assessment outcomes and reliability. Design: Within-subjects, repeated measures. Setting: Field. Participants: Physically active participants (N = 36) who regularly participate in basketball activity. Intervention: Subjects participated in 2 simulated basketball games, completing a symptom checklist, Standardized Assessment of Concussion, and Balance Error Scoring System before game play, during halftime, and at the completion of each simulated game. Pulse rate was assessed as a proxy of physical exertion. Main Outcome Measures: Total symptom, Standardized Assessment of Concussion, and Balance Error Scoring System scores. Results: Physical exertion did not significantly predict symptom, Standardized Assessment of Concussion, or Balance Error Scoring System scores, although a trend toward higher symptom scores was observed for females (ß = 0.03, P = .09). All assessments had poor to moderate reliability across sessions (.15 < interclass correlation coefficient [2,1] < .60). Conclusion: Low- to moderate-intensity physical activity did not have a significant effect on clinical concussion sideline assessments; however, the low test–retest reliability observed prevents strong conclusions on these relationships. The poor overall reliability does not allow for clear recommendations for what state of baseline physical exertion (ie, rested or exerted) provides optimal data to make postinjury clinical decisions, although baseline concussion assessments completed at rest have the most valid and conservative normative values for injury comparison.