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Friday, December 5, 2014

Accessory Navicular: Email Advice

Dr. Blake,

I have been intently searching the Web for some insight on accessory navicular and you seem like a Dr. with a solid understanding of the disorder.  I don't know whether or not you are willing to give me some advice but I thought I might ask???
Dr Blake's comment: The accessory navicular only occurs in 10% or less of the population. If you look at the illustration below, look first at the heel bone. As you move ahead towards the arch, you will see a small bone (accessory navicular) under a bigger bone (navicular). This is where the powerful posterior tibial tendon attaches and helps support the arch.The accessory navicular makes this attachment weak. 

My son is very athletic and loves to play basketball. 

 He was born with nice arched feet.  Last spring he was playing basketball with slip-on sandles and one of his bigger friends stepped on his foot injuring him.  He came home limping but was able to continue playing basketball.  While in a game a few days later something happened to this same foot, it rolled.  We backed off on it but it continued to hurt so we took him to Childrens ER where the Dr. diagnosed my son with accessory navicular.  He explained to some degree what we were dealing with.  The injury occurred in April 2013.  The Dr. gave him some arch supports and along with PT and Dexamethasone, and the Dr. said in 6 weeks he said he could start playing ball again.  We held out letting him play full B-ball until late June 2013.  After a two day tournament he said it was seriously bothering him again.  Needless to say, he started PT again and Dex.  In August we went to a specialist and he gave my son custom orthotics.  We leave the orthotics in his everyday shoes.  We bought him new basketball shoes and put some OTC sports orthotics in them with a high arch.  He is 13 now and playing school ball, he plays alot.
Dr Blake's comment: For playing he should be in the most supportive insert (based on his feel) and be taping. Try one of the taping techniques on my blog, or go to and order small size pack from them. Very supportive and can last a few days. 

His name is Luke and prior to his injury, never complained once about his feet.  He can run two miles right now with zero problems.
Do you think he is going to be fine or do you think this issue is going to keep surfacing? Dr Blake's comment: Unsure, but it is not a predictable sign that surgery is in your future. 
He is very inflexible, he cant come close to touching his toes, he used to be able to.  Do you think this is because of his condition??
Dr Blake's comment: Probably not, one growth spurt can do that to you. But, very important, unless it causes pain, to stretch out the achilles well on a daily basis. See the upper right stretch.

He walks like an old man sometimes, sometimes walking down the steps very slowly, especially after a day of playing hard.  Do you think this is because of his "AN"? Dr Blake's comment: Unsure, may just have played hard.
Other times he looks great on his feet. Dr Blake: When you have a really bad problem, you never look great until it is fixed. Kids are always hard to read. 

Do you think the Kinesiotape will help, if so how should I wrap it??

What type of strengthening should he be doing?

 Dr Blake: Find out which ones he can and can not do without pain. Pain actually shuts down the muscle and makes you weaker. I hope this helps some. Rich

Thanks for any input you may be willing give!!!  I would very much appreciate your input.

He used to run around all the time jumping everywhere now I really dont see him jump around that much, unless hes playing ball.

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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.