Tuesday, January 3, 2017
Accessory Navicular: An Accessory You Can Do Without!!
Hi Dr. Blake!
I have no idea if you will find this email, but at the very least, it is nice to write out the issues I have been having. I came across your blog while researching the accessory navicular and how to conservatively treat the area. I am a 27 year old, highly active/athletic female.
Back in July, while playing beach volleyball (to be clear, this was beer league volleyball, nothing too intense!), I suddenly had a sharp pain in my mid foot after landing from a jump. I have sprained my ankles a few times before, but this pain felt different. It was a sharper, more directed sensation right where (I thought was) my "arch bone", which I now know is the navicular bone. I kept playing, which was dumb. I then continued to ignore the soreness, as I figured it was just a minor tweak, nothing more (I would rate the pain in the morning about 5-6 out of 10). Over time, the pain reduced but I could not run. I am - well, was - an avid triathlete. I couldn't train any more because even walking more than 10 mins would be painful. Upon resting, pain would improve. After about 2 months of nothing getting better (and I know, I am kicking myself for not going sooner), I saw a physiotherapist for about 8 sessions to get some exercises to improve the situation, as my foot looked flatter than usual and with my previous ankle injuries, rehab was the key to tightening/strengthening the area back up. I have been doing inversion/eversion with resistance, along with standing on a bosu ball, standing on one foot, then icing & voltaren (diclofenac gel) etc. X-rays didn't reveal anything remarkable, other than an accessory navicular.
Finally, after getting an MRI and seeing the doctor, I was told I have a 'crack' between an accessory navicular bone and the true navicular bone, and the PTTD partially attaches to the accessory navicular. The extra movement of the accessory navicular is causing the pain, so it would seem.
Dr Blake's comment: That is common in a mis-step and that junction between the accessory and parent navicular bones can be the weak link in the chain.
So, I've started wearing an aircast with my orthotic in there, and will do so for the next 4 weeks (has been on for 2). I don't feel much improvement so far, and I had a brief stint where the aircast was causing a lot of irritation of the tendon, as it would swell and appear elevated through my skin. The cast was occasionally unbearable to wear...I have made some adjustments, but the only thing that has seemed to help is to deflate the aircast a little bit (though, now it feels like my foot is moving too much in there).
Dr Blake's comment: Since this is such a vital part of your treatment, get a removable boot that works. A medical supply store typically has some selection. You can see if ordering an Anklizer on Amazon and you can have it in a couple of days.
I guess my question is this - if the bone didn't heal for 6 months, and if the boot doesn't allow it to heal, how will I know when surgery is the next best option?
Dr Blake's comment: You will know in about 6 months. The steps you need to go are: 3 months in the removable boot, followed by 2-6 weeks weaning out of the boot. As you wean out of the boot, you need good orthotics that support the area, and learn at least 2 versions of taping (both somewhere on the blog). Strengthening steps with active range of motion, isometrics, progressive resistance, isotonic, and functional should begin now. You can strengthen each evening, with a little pain, as long as you can ice for 10 minutes after, and the next day you have no residual. Since you fractured the juncture, your health plan may approve an Exogen bone stimulator for the next 6 months. I always feel that these will heal, a few do not, and each month you should see improvement: less swelling, less pain, more function, more strength, etc. Hope this helps some. Each step can take some planning. I am happy if you want some more info. Give me more specifics. Rich
I hope this finds you in good health, and happy 2017!