Tyler Johnson/Track and Field 1/9/13 Time: 2:00 p.m.

S:Athlete reported to athletic training room c/p p! in right great toe. Fairly general, vague p! on both the dorsal and plantar aspects of patients medial foot. P! is apparent and most severe when in sprint spikes and especially during sprinting activities and when he is up on his toes. He is starting to feel it more consistently throughout the day and it is starting to bother him while he is walking around campus. His p! is a 2/10 throughout the day but a 7/10 during sprinting activity. Reports no neurological symptoms. O: Normal foot position. No pes planus or pes cavus observed. Normal feiss line test.No deformity, E, or sw. Evaluation revealed extensor tendonitis is great toe. Normal AROM dorsiflexion, plantarflexion, inversion, and eversion. Normal AROM great toe extention and flexion. P! with RROM great toe extension and flexion. P! during break test of great toe extensor, as well as during MMT. Positive tap test, percussion test. Negative tuning fork. P! on dorsal aspect of the flexor hallicus longus tendon on the midshaft of the first metatarsal. A: df dx. Includes flexor hallicus longus strain, stress fx of the 1st, 2nd, or 3rd cuniform, and stress fx of the navicular. STG include treating symptomatically and rehabilitate utilizing therapeutic bands and generally ankle/foot strengthening exercises. LTG is to have the patient running p! free at pre-injury status. P: Patient will perform rehabilitation exercises as written this week, and see a doctor as necessary next week after we have attempted conservative treatment. We will modify spikes as necessary. Corey Richards, ATS

1/15/13: Tyler had an appointment today with Dr. Hipskind. During appointment, Tyler stated that he had noticed this pain for a few months but it had gotten worse over the last week or so. He feels most of his pain during push off: occasionally he has noted some swelling in the area but there was none present during exam. Referred for x-ray. Corey Richards, ATS 1/18/13: Athlete had f/u appointment with Dr. Hipskind. His xray was essentially normal: large posterior os trigonum was present. He was learning more towards the likeliness that it was a tendon or ligament (soft tissue) and not a bone. After discussion with Coach Huntoon, we are going to place Tyler in a boot for the next couple weeks and give his foot a chance to heal leading up to the Big Ten Championships. He will complete bike workouts and see Coach Huntoon for technical workouts as pain tolerance allows. Update as necessary. Corey Richards, ATS

1/24/13: Tyler had an appointment today with Dr. Porter: referred for an MRI up in Indianapolis. Upon the results of his MRI, Tyler will report for a CT scan and see Dr. Porter to discuss both the results of his MRI and CT Scan, as well as a course for future treatment. Corey Richards, ATS 1/25/13: After MRI and CT Scan, Tyler has a stress fracture of his navicular that will require surgery. 4.0 screws to include a dorsal ongitudinal incision to remove the bone chip and percutaneus incision laterally to place the screw. He also has the option for non-operative treatment which would include: non-weightbearing for 6 weeks, along with a bone stimular and a follow-up CT 2 months from today. Operative treatment would include crutches for 6 weeks, Boot for 10 weeks, with a return to sports @ 5-6 months post-off. He will discuss his options with the coaching staff, parents, and academic advisor and get back to me with his decision. Will seek medical redshirt waiver for both indoor and outdoor seasons. Corey Richards, ATS 11/28/13: Athlete will have surgery this Friday at 2:30 in the afternoon at Dr. Porter's Carmel office. Reporting for pre-op at 12:30 at the office. Has been directed on fasting and dietary restrictions leading up to surgery. Parents have been contacted and can call me with any questions. Corey Richards, ATS 11/29/13: Patients surgery went as expected. Patient will be placed in an immobilizer and follow the RICE treatment method for the first 72 hours.