Jo,

I did indeed consider this, but given the duration one would expect to have
seen changes on X-ray or MRI?

Thanks for your help though.

Best wishes,
Simon


----- Original Message -----
From: <[log in to unmask]>
To: <[log in to unmask]>
Sent: Tuesday, February 19, 2002 10:31 PM
Subject: Re: Gymnast with AKP


> Date sent:              Tue, 19 Feb 2002 19:03:12 -0000
> Send reply to:          A group for the academic discussion of current
issues in podiatry              <[log in to unmask]>
> From:                   spoonz <[log in to unmask]>
> Subject:                Re: Gymnast with AKP
> To:                     [log in to unmask]
>
> All,
>
> Your thoughts please on the management of a 12 yr old gymnast (20 hrs per
week) with pain inferior to patella- X-ray and MRI have revealed nothing- my
best guess is pes anserine bursitis (the area was a little "puffy") and/ or
patella tendinits. She has tried rest and iceing without improvement.
> As expected this Pt is v. mobile. Gait analysis revealed ++ foot
abduction. Both navicular tuberosities were ++++enlarged and PT tendons
appeared to be somewhat anteriorly displaced around the medial malleoli.
Other than this, little to write home about. Given that this pt. does not
wear shoegear
> when performing, I am somewhat at a loss as to management- other than rest
and iceing (which has not helped previously). Your thoughts would be
gratefully received.
>
> Best wishes,
> Simon
>
> Have you considered Sinding- larsen-Johnsson syndrome Stage 1
> may will show normal findings on X-ray. As with patella tendinitis
> its common cause is a overload or traction type problem, possible
> cause eccentric phase of quadriceps usage ie landing from a jump.
> Aggrevated by tibial/femoral laxity rotation.
>
> Could try a patella brace or strapping to reduce patella mobility
> /recoil and to reduce the force transmitted through PFT.
>
> Regards
>
> Joanne
>
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