Dr Blake's comment: The edema/swelling seen within the os navicularis/os tibial externum/accessory navicular can take months and months to resolve after the initial injury, so not an indication that things are not healing. The pain above the ankle was one of the tendons trying to help out the injury: FDL, PT, FHL, or AT. When one area is injured, the surrounding muscles/tendons help out and do some extra work. That can make them hurt also. A Rule of Three tends to occur until the body re-establishes equilibrium---original problem, compensatory problem #1, and compensatory problem #2. The true injury is at the bump with the accessory bone however.
Dr Blake's comment: I am sorry the literature is so poor on this subject. Yes, some patients need surgery. Doctors have a hard time deciding on surgery on someone that age, so feet get dragged.
- Perfect the orthotics
- Perfect the soccer cleats
- Avoid barefoot at home if that bothers the area
- Learn a variety of taping methods
- Ice and Contrast Bath daily
- Eat healthy
- Talk to the coach about a gradual return to soccer, and any ideas on position change
- Tell the physical therapist you want to learn a pain free gradual and progressive strengthening program so 6 months from now you/she have tendons of steel (at least 3 times stronger). Good Luck!!
Accessory Navicular: An Accessory You May Want To Do Without
X ray shows accessory navicular under the navicular at the height of the arch.
This MRI view of an Accessory Navicular shows it inferior and closer to the heel than the big toe.
MRI view on the partial bone attachment of the accessory navicular.
- Get the acute pain calmed down with an Anklizer Boot, an EvenUp for the other side, anti-inflammatory. You will need the boot and EvenUp again.
- Get an MRI to look at the tendon, attachment of the bones, spring ligament, tarsal coalition, and tarsal tunnel areas.
- If the MRI shows a lot of bone activity, get a bone scan.
- Talk to a Physical Therapist about isolating the posterior tibial tendon during strengthening. Can you do at least isometrics without pain? Begin strengthening the tendon, same exercises are needed post operatively. Strengthening should only be done in the hour before bed, and ice after even if it does not hurt.
- Get an orthotic that is comfortable, but supports your arch. Are there doctors or therapists in your area that use a version of the Inverted Orthotic Technique? You must feel that the orthotic works so well that you do not need to pull up your arch.
- Ice three times daily period. For 15 minutes each. Since you can wrap ice around the top and inside of your foot and walk around the house, at least you can do other things.
- Learn to Kinesiotape your arch or check out the tape from suportthefoot.com. Tape daily. You can ice through it.
- Do not go around with sandals or barefoot. Dansko clogs may work. A compromise may be an Orthaheel or Chaco Sandal with Kinesiotape.
- Feel free to send me any tests along the way. You have a big journey. Hang in there. Be Logical. I hope this has helped. Rich