Home The Book Dr Articles Products Message Boards Journal Articles Search Our Surveys Surgery ESWT Dr Messages Find Good Drs video

accessory navicular or old fracture?

Posted by Natalie R. on 3/22/02 at 14:35 (077231)

I've been having pain in my foot (at site of navicular bone) since August.I run about 10-15 miles a week, and this seemed to be what caused the pain. I just saw a dr for the problem and x-rays were taken. The doc said it could be on of two things. Either I fractured the bone (there is ossification so it would be an old fracture, though he says it's impossible to tell how old) or I have an accessory navicular bone. I was told the two look so similar that it's hard to tell for sure without a bone scan. And apparently, the treatment for either is similar so it doesn't matter at this point?

He put me in an air cast to bring down the pain in that area. And I've been told not to run or walk for fitness. I'm in pt, and the trainer told me that my hips were misaligned, which may have caused the pain to begin with. I guess they want to see if they can fix my mechanics problems with pt and then release me to run/walk in two weeks. They say if the pain returns immediately then I will be sent for a bone scan.

So, what would the bone reveal that the x-ray is not, and how would that affect the course of treatment? Is it true that there is no way to tell precisely from an x-ray whether or not it is an old fracture or an accessory bone? What are the odds I will require surgery for this?

Should I seek a second opinion now, or wait to see if the problem resolves itself with this treatment?

Many thanks!!

Re: addendum to below message

Natalie R. on 3/22/02 at 14:52 (077235)

One thing is, the pt said if it were a fracture, it was a complete fracture, not a stress fracture and would have required twisting my ankle with force. If I had fractured this bone in that way in the past, would I have been able to continue to walk/run on it? I started having pain in August. It is possible that I twisted my ankle prior to the pain starting but nothing stands out in my mind.

Also, if it is accessory navicular will I have it in the other foot too? I don't want to start having all kinds of problems with my feet!!

I've been running for a while now--probably 5-7 years. If it is an accessory bone, is it unusual to be asymptomatic for so long and then all the sudden have this chronic problem?

The doctor called the condition 'acute' right now. What does this mean?

I want to be able to run again!

Re: accessory navicular or old fracture?

DR Zuckerman on 3/23/02 at 02:47 (077271)

doing an x-ray of the opposite foot will help. It there isn't the same number and size boen then it is a fracture. It cast and rest and maybe orthosis doesn't help the foot then removal is the treatment. Give treatment some time. I look at it this way the treatment would be the same whether it is fractured or not so who really cares at this point, but the comparitive x-ray is the answer to the diagnosis

Re: accessory navicular or old fracture?

Dr. David S. Wander on 3/24/02 at 19:16 (077448)

I have to respectfully disagree with Dr. Zuckerman. Sorry Dave! Although an x-ray of the other foot may be helpful, it will not give a definite answer whether the accessory ossicle is a fracture. The accessory bone can be attached to the navicular via cartilage, soft tissue or bone, and the actual accessory bone is not usually fractured, but the connection (interface) between the accessory bone and navicular bone is usually disrupted and often there is a partial tear of the posterior tibial tendon. I would highly recommend an MRI to determine whether there is an injury to the tendon and the characteristics of the relationship between the accessory bone and the navicular. I do agree with Dr. Zuckerman that the treatment won't differ greatly, and immobilization should be stronly considered.

Re: accessory navicular or old fracture?

DR Zuckerman on 3/24/02 at 19:22 (077449)

You always disagree with me. No more plantar injections. By the way I would like to announce that DR. Wander is now going to be using the Dornier EPOS unit and is part of our shockwave therapy group.

Re: accessory navicular or old fracture?

Dr. Wander on 3/25/02 at 18:27 (077538)

Always disagree???? Come on Dave, you're being too sensitive today. You're going to give people the wrong idea!! I'll give you a call tonight regarding our meeting on Wednesday. By the way, I don't ALWAYs disagree.

Re: accessory navicular or old fracture?

Dr. Zuckerman on 3/25/02 at 18:51 (077543)

Ok Dr. Wander and Dr. Zuckerman are friends . I like to tease him. !!!!

Re: addendum to below message

Natalie R. on 3/22/02 at 14:52 (077235)

One thing is, the pt said if it were a fracture, it was a complete fracture, not a stress fracture and would have required twisting my ankle with force. If I had fractured this bone in that way in the past, would I have been able to continue to walk/run on it? I started having pain in August. It is possible that I twisted my ankle prior to the pain starting but nothing stands out in my mind.

Also, if it is accessory navicular will I have it in the other foot too? I don't want to start having all kinds of problems with my feet!!

I've been running for a while now--probably 5-7 years. If it is an accessory bone, is it unusual to be asymptomatic for so long and then all the sudden have this chronic problem?

The doctor called the condition 'acute' right now. What does this mean?

I want to be able to run again!

Re: accessory navicular or old fracture?

DR Zuckerman on 3/23/02 at 02:47 (077271)

doing an x-ray of the opposite foot will help. It there isn't the same number and size boen then it is a fracture. It cast and rest and maybe orthosis doesn't help the foot then removal is the treatment. Give treatment some time. I look at it this way the treatment would be the same whether it is fractured or not so who really cares at this point, but the comparitive x-ray is the answer to the diagnosis

Re: accessory navicular or old fracture?

Dr. David S. Wander on 3/24/02 at 19:16 (077448)

I have to respectfully disagree with Dr. Zuckerman. Sorry Dave! Although an x-ray of the other foot may be helpful, it will not give a definite answer whether the accessory ossicle is a fracture. The accessory bone can be attached to the navicular via cartilage, soft tissue or bone, and the actual accessory bone is not usually fractured, but the connection (interface) between the accessory bone and navicular bone is usually disrupted and often there is a partial tear of the posterior tibial tendon. I would highly recommend an MRI to determine whether there is an injury to the tendon and the characteristics of the relationship between the accessory bone and the navicular. I do agree with Dr. Zuckerman that the treatment won't differ greatly, and immobilization should be stronly considered.

Re: accessory navicular or old fracture?

DR Zuckerman on 3/24/02 at 19:22 (077449)

You always disagree with me. No more plantar injections. By the way I would like to announce that DR. Wander is now going to be using the Dornier EPOS unit and is part of our shockwave therapy group.

Re: accessory navicular or old fracture?

Dr. Wander on 3/25/02 at 18:27 (077538)

Always disagree???? Come on Dave, you're being too sensitive today. You're going to give people the wrong idea!! I'll give you a call tonight regarding our meeting on Wednesday. By the way, I don't ALWAYs disagree.

Re: accessory navicular or old fracture?

Dr. Zuckerman on 3/25/02 at 18:51 (077543)

Ok Dr. Wander and Dr. Zuckerman are friends . I like to tease him. !!!!