Dr Blake's comment: Pain from an accessory navicular bone normally presents in children around 13-14 at the earliest. The accessory navicular bone is on the arch side (big toe side of the foot) where the powerful posterior tibial tendon attaches, it is the main tendon in supporting the arch of the foot. Very important!! We know that the accessory navicular bone can cause direct pain where it attaches to the normal navicular bone, or cause tendon pain since the extra bone disrupts the normal attachment, weakening the tendon, causing the tendon to strain easier. This is usually an easy diagnosis when the patient points to the accessory navicular and says it hurts right here!!! You got to make it easy for us patients!!
However, the pain that your daughter presents with is on the opposite side of the foot and ankle (outside or lateral side). This presentation, along with negative X-rays and MRI, leads me to suspect a mechanical cause of her pain like over pronation (perhaps indirectly caused by the accessory navicular bone.
Dr Blake's comment: The immobilization had fixed the tibial growth plate fracture. The new pain, one year later, is 99% not related to the original problem, especially since it is in a totally different area.
This completed perplexed the orthopedist and he sent us home, assuming that she had either strained it or just liked visiting the doctor on a regular basis. Fast forward through almost a year of soccer games, swim team, summer trips to the water park, and flip flops and we are officially in AGONY.
Dr Blake's comment: At least now the picture is getting clearer. 1 year ago she injured herself with a new injury, has had no treatment for that injury, and is not getting better. Since the injury involves no broken bones, bones sticking out of the foot, or torn tendons, the treating doc figured a little time will heal the problem. 95% of the time, it probably does. Your daughter fits into the 5% that really needed more treatment.
Since I refuse to go back to the orthopedist who dismissed us, we've been back to the pediatrician's office, had more X-rays (normal), seen an exercise science specialist ("Go back and play soccer. You're fine. I guess we can try PT too."), seen a sports medicine PT ("Um. . . I don't work with 8 year olds and I'm not sure how to treat a problem without a proper diagnosis."), and FINALLY we raised enough hell to get her an MRI, which is of course normal.
|Here is the photo of the back of the legs/feet. Both heels are pronated (ankle bones collapsing in). As the arches collapse, from the back you can see more of the fifth toe.|
|That overpronation is much clearer on this photo with the right side leaning inward. Golden Rule of Foot: When the pain can be from asymmetrical pronation, fix that first and see if the pain is diminished.|
Is there anything we can do while we wait until February to see the Holy Grail of (adult) ankle specialists at Duke? When your child comes to you everyday in pain, it's heartbreaking.
Dr Blake's response: