Pain in navicular 6 years after surgery

by Beth
(Wyoming,US)

I am a 35 year old woman, overweight,used to be athletic but can't do it because of foot pain now. I had surgery to repair a stress fracture six years ago where a screw was put in and a piece of the bone that broke off was removed. Ever since then I have had most of the time constant pain in the navicular area especially when pushing off when walking. The past two days it has been excruciating to walk. I have been to many doctors and all they want to do is x-ray it and tell me nothing is wrong. As it was it took three years to diagnose the stress fracture had not healed after immobilization for six weeks. I am at my wits end. Please help

RESPONSE

Hi Beth,

I do not know where you have been going for your medical advice for this problem but if you have been using local doctors one of your options would be to travel to a large university based medical center. Doctors at these institutions tend to be better equipped to handle "out of the ordinary" medical problems, simply because they see more of this than local doctors.

I mention that because I cannot believe that all the doctors you have seen only want to take an x-ray. You are beyond the x-ray stage. If you walked into my office, yes, initially I would take an x-ray, but then seeing that the x-ray appeared normal, BUT, my patient was in a lot of pain and knowing that surgery had been previous performed, I would at the very least order an MRI to get a much better picture of what is going on in your foot.

It is impossible for me to diagnosis what is still causing you so much pain, but certainly the possibility exists that there is still a fracture of some sort going on that has not been remedied by the placement of a screw.

Then there is always the possibility that the screw itself is the problem. Hardware does serve a purpose initially, but in many instances it can then become the source of pain. In those cases the hardware (screw) may be removed.

There is also the possibility that the navicular bone itself is not the real issue here, but perhaps the tendon that attaches into it, the tibialis posterior tendon is somehow damaged or malfunctioning as a result of the surgery that was performed.

I am curious as to whether you wear any kind of arch support or orthotic in your shoe. Assuming you do and assuming it actually supports your arch, you might get relief simply because a good orthotic would stabilize the navicular bone and take some of the tension off the tibialis posterior tendon as well. If you are not presently wearing one, I suggest you try one at least until you can find a doctor who can figure out what is going on with your foot.

As I just mentioned, you should inquire about an MRI. This test would better visualize any small fracture you may still have, where an x-ray would likely miss it. An MRI would also give a better visualization of the tendon attaching into the navicular as well as any potential ligament damage.

In summary, you need to find a doctor who is going to be a little more proactive about a problem that has been going on for so many years without resolution.

Marc Mitnick DPM
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