Tuesday, October 1, 2013
Coalition: Painful Problem poses Difficult Decisions
Dear Dr Blake
I have a calcaneo-navicular coalition that has caused me pain over the past 6 months. I am 32 years old, and up until 6 months ago have never had an issue with my feet, despite being an avid gymnast, and then runner. I used to do upwards of 50 kms per week.
Since March 2013 I have stopped running – there was one day where I was walking around barefoot all day, without my orthotics/supportive shoes (I have had orthotics all my life). Woke up the next day and was in pain. Since March I have had pain when walking.
I had an MRI and bone scan, and they revealed there is a coalition with some irritation of the bone at the site of the coalition. I had a cortisone shot nearly 2 weeks ago and it has taken away a significant chunk of the pain but I can still feel the stiffness.
Thank you for your blog –I am currently icing my foot now after reading it.
My question is – I would be happy to take another 6 weeks off running if I had a 2nd shot – just to put this whole thing to bed. Do you think that is a good option?
The other option according to my surgeon is resecting the coalition but he thought the cortisone would work.
Dr Blake's comments:
Thank you so very much for the email. I think you are doing well, and would limit the cortisone shots as much as possible. If you need them to avoid surgery, go for it. You would do another cortisone shot to reduce to the pain to between 0-2, and this has already been done. There is no reason to do more now. There is no reason to consider surgery either, for this may be an isolated incident. Typically, orthotic devices do well for CN Coalitions, so I would see how the next 6 months to a year goes. I like my patients to be able handle reflares when they occur. If this area flares in 2 or 3 months, you will be very discouraged, if you do not have a plan to reduce the pain quickly. Typically this means removable boot, icing, taping, activity modification and NSAIDs. Do you have all this? Do you know how to do a great low dye? You need to be a great foot taper!! See the videos below. I hope this helps. Please give me some followup. Rich