Accessory Navicular: Blog Comment

Dr Blake, My daughter is 9 years old and started having feet pain off and on last summer. Since January it became more consistent and now it is daily. We initially went to a orthopedic doctor and he referred to PT and a podiatrist. In the mean time we bought New Balance shoes and insoles. She btw was determined to have collapsing arches that had apparently aggravated the supporting tendon. During PT we started noticing a place on the inside of her left foot that now protrudes all the time and is very tender. We have also been to our family physician. Everyone just wants her in arch supporting insoles. We have been given anti inflammatory creams as well. Nothing works! We have tried all creams, advil, several different insoles, icing, stretching and physical therapy. We also took her out of karate, and reduced other activities. My daughter is in pain every day. They say her xrays are normal. Below the navicular bone there are 3 little pebble looking shapes. I am wondering if that extra bone is forming??? I am just at a loss of what to do next. Every shoe we have seems to really aggravate the protrusion on the inside of her foot. Any advice would be appreciated.

1. Dr Blake's response:
2. Thank you for your comment. Definitely sounds like the beginning of accessory navicular syndrome for sure. Buy some 1/4 inch adhessive felt which you can adjust/thin as needed to build a horseshoe accommodation for shoes. You really need to get her into a removable boot for 3 months to begin the Immobilization Phase ASAP. This should be accompanied with 10 minute ice packs three times a day. Since there is always time a home that she will walk without the boot, she will know if it is getting better. You stay completely in the boot 2 weeks longer than you need to. During the boot time, you have a podiatrist make a custom orthotic device with an accommodation. Hope this helps your daughter heal faster. Rich