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Pain on navicular tuberosity

Posted by Claudio F on 9/14/03 at 12:42 (129968)

According to an X-ray by my podiatrist, it looks like I might have an accessory navicular bone on my right foot. I have chronic pain right in the region of my navicular tuberosity. I feel a deep pain when I press hard either on or around the navicular tuberosity especially on the underside of it. I sprained my right ankle by inverting it and got a moderate sprain, but the pain on my navicular tubersoity was much more intense than the pain on the outside of my ankle. Recently I inverted my ankle again playing soccer and I got no pain or swelling on the outside of my ankle, but I got intense pain around my navicular tuberosity which is taking 2-3 months to heel to a point where I could run again without intense pain.

The pattern is that whenever I slightly invert my ankle, I get a flare up in the pain which lasts for 2 -3 months before I could play soccer again. Then after it heels, the pain is tolerable but it is always there. It basically never fully heals. I have low arches and wear orthotics.

I am 48 and I badly sprained this same ankle about 25 years ago, was in a cast for 6 weeks and never had physical therapy to reabilitate. I also experience stiffness in foot and ankle every morning which gets better with calf stretching.

The podiatrist said it is a strain in the tendon that attaches there and he says to simply rest and ice it.

Do I have to just live with this?

Re: Pain on navicular tuberosity

Dr. Z on 9/14/03 at 13:58 (129976)

An orthoiss can help you alot. Did you your podiatrist mention a biomechanical and or gait evaluation to determine the role your foot function has in your injury and posterior tibial tendonitis.?

Re: Pain on navicular tuberosity

Dr. David S. Wander on 9/14/03 at 19:24 (130003)

As per Dr. Z's recommendation, an orthosis may be beneficial to support the navicular and posterior tibial tendon. Often, the accessory bone has a fibrous attatchment to the navicular. With trauma or repetitive injury, there is tearing of the interface between the accessory bone and the navicular. This is from pulling of the posterior tibial tendon which has attachments to this area. An MRI is useful to determine whether there is any partial tearing of the posterior tibial tendon or injury to the accessory ossicle. It is sometimes necessary to surgically remove the accessory bone, reduce the bony prominence of the navicular and tighten down the posterior tibial tendon. This procedure often provides very dramatic relief, when indicated.

Re: Pain on navicular tuberosity

Claudio F on 9/15/03 at 20:30 (130128)

Thankyou for your response.

As I mentioned in my post I already wear orthotics. Is that what you mean by orthoiss? My podiatrist never mentioned a biomechanical or gait evaluation.

Re: Pain on navicular tuberosity

Claudio F on 9/15/03 at 20:34 (130129)

Thankyou for your response. It was very helpful.
Again, as I asked Dr. Z in my response to his response, is an orthosis the same as foot orthotics because I already wear foot orthotics which do help, but apparently not quite enough. Without the foot orthotics, it would be impossible to walk.

It was also very helpful to learn about the use of an MRI to help narrow down the possibilities you mentioned.

What is the recovery time to full functioning in a sport like soccer after the type of surgery you mention?

Re: Pain on navicular tuberosity

Ed Davis, DPM on 9/15/03 at 22:12 (130161)

I agree with Dr. Z and Dr. Wander. Definitely go with the orthotics. Although, there a number of patients who have very problematic accessory navicular bones that require removal. A procedure known as the Kidner procedure involves removing the accessory navicular bone and then advancing the portion of the posterior tibial tendon that had attached to the accessory navicular into the main portion of the navicular. This is one area where surgical treatment may be needed depending on the size of the accessory navicular and the amount of trouble it causes.

Re: Pain on navicular tuberosity

Dr. Z on 9/16/03 at 19:42 (130282)

So either an Ankle foot orthosis or well surgery as Dr. Wander has explained

Re: Pain on navicular tuberosity

Claudio F on 9/16/03 at 20:20 (130293)

Is an ankle foot orthosis different than just regular foot orthotics?
Can you play a sport like soccer in an ankle foot orthosis?

Re: Pain on navicular tuberosity

Ed Davis, DPM on 9/16/03 at 21:02 (130297)

An ankle-foot orthosis has a portion that attaches to the ankle. The people who make the Richie brace make a special one just for soccer -- it has a built in shin guard.

Re: Pain on navicular tuberosity

Dr. Z on 9/16/03 at 21:05 (130300)

yes. you can play sports with an Ankle foot orthosis