Navicular avulsion # in teen

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Hi

About a year ago I consulted a 14 year old female, very active in sports especially running. She presented with an avulsion # of the Navicular. An MRI showed Post Tibialis tendon insertion involvement.
Once the orthopaedic surgeon removed the cast, she underwent an extensive biomechanical examination with the following signifcant findings:
1. Forefoot varus with compensatory hyperpronation
2. Abduction with tibial torsion of 7degrees
3. No LLD or pelvis abnormality
4. Stable ankle especially medial deltoids
5. Disparity in strength between antagonists and protagonists of lower limb - ant tib weaker than post tib.

She was treated in a team including physio, biokineticist, podiatrist - rigid 3mm polyprop. - orthotic that held the foot in neutral.
She repsonded extremely well.

Now, a year later her injury has recurred. I am yet to see her, but expect to find compliance in orthotic wear and/ or wearing down of the orthotics postings plus innappropriate shoes as possible reasons for recurrence.

Any advice?

Regards

Brandon

 

Hi Brandon:
If she indeed had a separation of an accessory navicular she will be predisposed to recurrence.
The Tibialis Posterior always shows inflammation on MRI with these ( at insertion)

Does she play a sport?

If continued Orthotic therapy fails to give her long term or dramatic relief (along with PT) I would suggest resection.

Steve

 

Hi Steve
Yes, she is active in sports especially in running.
I will certainly monitor her progress. If recurrence is on the cards due to failure of orthotics to continualy relieve her symptoms, I will consider ressection.

Thank you
Brandon

 

How much pronation is 'hyper' pronation??

Did it really???

 

Hi Brandon,

Just to :welcome: you aboard.

I notice Steve & Ian have already responded to your initial post.

Many regards,

Mandy.