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Thursday, October 17, 2013

Navicular Pain: Email Advice

Hello Dr Blake my name is Ron (name changed) and I live in Oregon. 

I have be diagnosed with Posterior Tibial Tendon Dysfunction. 

In 1988 I broke my Left ankle in a fall and and as a result I was left with a slight loss of dorsiflexion but not enough to keep me from running and riding my bicycle. I had a 20 year career of racing bicycles = Cyclocross which is riding and running without any problems. I have always known that I was limited in dorsiflexion but it was never a limitation for me.

In December of 2012 I bought a pair of shoes that have no built up heel so the thickness of the heel and fore foot are the same thickness.  They felt great and seemed to make my feet feel like they were getting stronger. At the same time I was skate skiing every weekend and began to develop a pain in my foot after skiing that would go away during the week and come back after skiing. 
This continued to develop into more pain centering on the navicular bone

My own theory was that the shoes without any heel height made my foot come into dorsiflexion sooner than if you were wearing a heel which pushed my foot into pronation. 
Dr Blake's comment: This was my exact thought when you mentioned the zero drop shoe. Not good if you have limited ankle dorsiflexion, and it is not merely an achilles flexibility problem. 

It took several months to figure out what was going on and now I have some orthotics which have helped quiet the pain in the navicular down some but not completely.  I have new shoes with heels that let my foot not have to go into dorsiflexion so quickly. I am able to ride my bike with stiff cycling shoes and a orthotic. 
I am Icing 2x a day and use my orthotics most of the time. Should I be doing the strengthening exercises daily?
Dr Blake's comment: First of all, all we are sure off is that you have arch pain. Pain at the navicular does not mean you have posterior tibial tendon problems. That being said, pain in any area should be treated with strengthening as much as possible. As you do foot strengthening as in the video below, see what muscles are weak and emphasize them. If it is the posterior tibial tendon, then that may point to PTTD. 

Will this tendon quiet down again now that I am not aggravating it?
Dr Blake's comment: Typically it will. But, you should ice 3 times a day for 10 minutes, gradually strengthen the area, wear supportive shoes/taping/orthotics as you increase activities, gradually stress it with a progression of activities from slight to more stressful on the area.

I would be willing to come see you if you think you can help me. 
Thanks for taking the time to read this. 

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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.