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Two Diagnoses and how to understand them?

Posted by Louise on 7/05/04 at 00:42 (154507)

First Diagnosis from Foot and Ankle Orthopedist: Accessory Navicular in both ankles. No orthotics and lots of PT with various ankle strengthening exercises including BAPS board and calf stretches.

Second Diagnosis from well respected Podiatrist: Insertional Tendonitis of the anterior tibial tendon. He feels this is also pulling on the plantar fascia area, which often hurts and cramps.

Podiatrist says accessory navicular issue not central. Recommends PT with ultrasound, calf stretches, NO BAPS board and NO ankle stregthening exercises that will pull my foot toward me. He recommends a rigid orthotic but recognizes I already have one I cannot wear. I've convinced him to make me a 'soft orthotic' as a temporary measure.

I'm more inclined toward the second opinion by the Podiatrist as I've had many bouts of insertional tendonitis in many tendons throughout my body through the years.

How can I walk without irritating the anterior tibial tendon? After several blocks it begins to seriously hurt right in front of the ankle bone. I do better if I don't bend my ankle at all but most ankle elastic bandages seem to make it worse.

Thanks for any thoughts and suggestions - I really feel very confused by the contradictions in recommendations from the two doctors.


Re: Two Diagnoses and how to understand them?

Ed Davis,DPM on 7/05/04 at 12:36 (154534)

I would be inclined to have you mark the area that hurts with an indellible marker after inducing pain by walking -- need to know if the area of pain is at the tibialis anterior insertion or at the accessory navicular. Also, we no biomechanical information to go by without an exam -- did either doc mention whether you overpronate?

Re: Two Diagnoses and how to understand them?

Louise on 7/05/04 at 23:12 (154574)

Yes - I definitely overpronate and always have. The orthotics that used to help me quite a bit were posted to lessen the over-pronation.

I don't know how to figure out exactly where the pain is and it is often where the ankle bends right in front of the ankle bone, and also under the arch, often in the plantar fascia area - usually in the part nearer the big toe. If I try to walk without bending my ankle, it definitely lessens the pain.

Could you direct me to a picture of where the accessory navicular would be? I found a picture of the anterior tibial tendon and it looks like it's there - if I had to guess, of course in relative ignorance :-)