My 13 year old was just diagnosed with accessory navicular in his right foot. He only has pain during sports, baseball and basketball. Doctor does not recommend surgery now. We are obtaining orthotics for his shoes. My question is should he do anything other than orthotics and some PT exercises? I read where casting or boot is sometimes prescribed. Our current doctor did not recommend either. He did say that surgery is usually inevitable but we should delay as long as possible. Any different opinions.
Post by Jason Ahuero, MD on Aug 12, 2009 20:03:50 GMT -6
I agree with the recommended first line treatment being a good orthotic to support the arch, PT and activity modification. If he is acutely painful with normal walking, perhaps a trial of a walking cast or a CAM boot for a short time followed by orthotics may be of some benefit. You will want to also make sure that exernal pressure over the medial midfoot from his current athletic shoes is not contributing to his pain. As you have noted, surgery is usually necessary if the pain remains intractable after a long course of conservative treatment.
Thanks for the reply. Fortunately he has no pain in normal walking. What options do you have if shoe is hurting? Do you wrap the foot or use a compression sleeve? Also, do you see any benefit to immobilization during sleep through use of an ace wrap or splint?
Post by Jason Ahuero, MD on Aug 14, 2009 17:47:15 GMT -6
If his shoe seems to be putting pressure on the accessory navicular I would make sure that the leather upper portion of the shoe is not too tight over the navicular prominence. If it is, you could consider having a pedorthist or shoe shop stretch the upper (using a "shoemaker's wand") over the prominent accessory navicular. Or, consider getting a new shoe with an upper made of a mesh nylon that can stretch over the painful area. If the foot swells with activity, ice and compression are usually helpful. As far as night splinting, I don't see much benefit as a painful accessory navicular is usually caused by the pull of the posterior tibial tendon, which attatches to the navicular tuberosity and is mainly active in the toe-off part of stance phase and is not really active during rest.
Post by qwertyuiop on Apr 26, 2011 17:39:13 GMT -6
hi my name is Lauren i have accesssory navicular as well as your son, i had a cast, the cast only made it worse, i now have 500$ orthodics which dont work either, my next option is surgery, i have a friend who had to get the surgery also cause the exercises and cast and boot did not work, i would suggest going to childrens hospital
Last Edit: Apr 26, 2011 17:40:23 GMT -6 by qwertyuiop
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