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Thursday, August 23, 2012

Day 2: Accessory Navicular Syndrome

Day 2: Accessory Navicular Syndrome (A Discussion of Samantha's Dilemma)

     Less than 5% of us are born with an extra arch bone which can give us fits at times. This extra bone is right where the most important tendon that supports the arch attaches, so it can cause pain, arch collapse, or just an obnoxious bump. The tendon is called the posterior tibial tendon. This accessory navicular is commonly called Os Navicularis, Os Tibial Externum, or The Second Ankle Bone. I have many patients who come for second opinions when they become painful, and someone justifiably wants to remove it. Some do need to be removed, but many can become asymptomatic thus avoiding the surgery.

     Like any injury, there are phases the patients must go through to get well. Patients can be in 1 or more phases at a time. But, it is important to recognize what phase you are in, so you do not get too frustrated. The phaseYs of injury rehabilitation are: Immobilization/Anti-Inflammatory Phase, Re-Strengthening Phase, and Return To Activity Phase. Each phase should be individually orchestrated for that patient. Normally, you are 80% better when you begin the Return To Activity Phase. You are 100% better when you are back doing everything you want.

      In this email from Samantha, the doctor did the right things-- arch supports for the Immobilzation Phase, and exercises to begin the Re-Strengthening Phase.

Email from Samantha

Dear Dr. Blake,

Thank you for posting up helpful tips about foot and ankle problems. Recently I have been for a consultation with an orthopedic surgeon ( which cost me so much), and he has diagnosed me with Accessory Navicular Syndrome ( attached herewith is an X-Ray of my foot), my left foot collapses inwards to an extreme and I have extremely flat feet. He has advised me to go for physio therapy to strengthen the posterior tibial tendon, as well as to constantly wear arch supports.

My problem is here, the reason why the pain has flared up is because I have recently picked up the sport of running, which I really like to do. However, sometimes when I run, it always reaches a point where there is a sharp pain at that area and I have to stop. It then goes away after a while, but then comes back again when I start running. I am determined to not have to give up running.

I have followed his advice and got special insoles with arch support for my running shoes ( -these are the ones particularly), however due to the insoles I keep getting blisters on my heels which puts me in a different painful situation all together. I always feel very frustrated with my feet, because they restrict me in so many different ways. The insoles do help to a certain extent, but the pain is still there. I fear I may not be wearing the proper type.  I was thinking of getting custom running shoes, but I am not too sure what is the right type and what properties should the shoe have. Was hoping you could give me some advice on this, or what should the proper insole should be and how can I over come the blisters?

I have been also wanting to go for physio therapy to strengthen the tendon, however it is just so costly here in my country that I keep putting off. Do you have any tips on how I can strengthen it for my certain condition?

Thank you so much in advance for your help Dr. Blake, I really hope to hear from you soon.

Kindest Regards,
Samantha (from Malaysia) name changed

Dr Blake's Response

Samantha,thanks for the email. If you bought the Sole arch supports you can oven heat them for a better custom fit which may help. You can buy a roll of 1/8 inch adhesive felt from Moore Medical to pad areas for support or protection. You can use Body Glide before running in the areas you get blisters. Buy Kinesiotape or Rocktape and see my post on arch taping. You may need to go to a custom device via a sports podiatrist at some point. Without knowing your biomechanics makes it hard for an exact shoe rec, but go to good running shoe store that sells Brooks Ariel, Brooks Addiction, or Brooks Adrenaline. Ice the side of your foot for 10 minutes 3 times daily for the next month whether you run or not, and see how that works. Hope this helps and keep me in the loop. Rich
Samantha's Response

Dear Dr.Blake,

Thank you so very much for your advice. You are awesome!

As soon as I saw your post I went out to get Rocktape and followed your post on arch taping, we don't have body glide here in Malaysia,so I looked for alternatives online and tried Vaseline, which worked really good, I also decided to purchase anti-blistering socks.I also heated up my soles for a custom fit.And the results, my pain was reduced tremendously during my run today, to a point it was almost non existent ,but of course it was still a lil there =) In fact, I don't seem to have that pain at the bone area I usually feel after running.

I really can't thank you enough.But thank you so much for your advice. My next step will be to check out the Brooks shoes or a custom shoe.

Thank you so much.

Kind Regards,

Dr Blake's Response

You are welcome. Right now try to find an every other day running distance that does not seem to push it too far and cause pain. Stay at that distance for 10 runs and if all works out increase by 10% the next 10 runs, and so on. Good luck. Rich

     Each of these case histories is packed with truths that I call The Golden Rules of Foot. Golden Rule of Foot:  Ice for 2 Weeks longer than you think you need to ice.

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.