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Sunday, December 4, 2016

Navicular Pain: Email Advice

Hi there Dr. Blake!

Searching around the internet I came across your blog and I'm hoping you can help me?
I have been suffering from pain of the navicular bone and all around the navicular bone.  As you can see from the photos, it sticks waaay out, although X-rays have come back "normal"?? 
Dr Blake's comment: I did not receive the attachment with the photos, but an MRI should be done to look at the 3 dimensions of the injury. 

 The attacks began in August (it is now early Dec) and are becoming increasingly frequent.  These attacks begin as twinges in the medial area of my left foot, the area then burns and on occasion swells.  The attacks are leaving me hobbled and unable to weight-bear.  
This doesn't work for me as I am an active primary school teacher, I don't even have a chair at my desk, that's how little I sit!  I'm losing work time and this needs to be fixed.
Dr Blake's comment: The problem could be an accessory navicular, and also nerve pain from the back or ankle in the tarsal tunnel. Some patients just have a large navicular than interferes with the posterior tibial tendon and causes tendinitis.  Other than an MRI, you want to treat the area with taping, orthotics, and shoes for great support, and icing right now for 10-15 minutes three times a day for the inflammation. 

  I have seen a podiatrist and chiropodist who have said that my left leg is slightly longer than the right, which has caused my left foot to flatten and is tearing my posterior tibial tendon.  The attacks seem to come on out of nowhere, no rhyme nor reason which is what confuses me.  If I had such an issue, wouldn't the pain be constant? 
Dr Blake's comment: The neuropathic pain, arising from the nerves, typically behaves like this. The cause can be the pronation, which stretches the nerve as it comes around the ankle. Nerves hate to be stretched. Thus, trying to figure out the right amount of support, whether the nerve can take any compression from the tape, and if there is low back involvement. 

 And where did it come from all of a sudden?  I have orthotics coming in mid-December but am worried that they won't help the situation as I have been wearing drug store arch supports and supportive shoes and I still had an attack after a week or two.  I'm so worried I may not be able to exercise anymore!!  Please help!!!  What can I do to properly diagnose and fix this???  I'm hoping to get in to see an orthopaedic surgeon next. But that could take months!!!
Dr Blake's comment: I sure hope a custom device made for you will be better than store bought!! Did the doc who made them thus what was going on, what the role of the orthotics, if they can be adjusted, etc etc. Definitely keep me in the loop. Rich

Thank you in advance,


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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.