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Have an 11 year old with Os nav present, unilateral pronation, is able to single leg raise....just and heel does invert. Is pain on palo the nav and PT insertions.
What is the difference between these 2?
Have so far been immolibising where possible, have orthoses with padding arround the nav area with a horseshoe, using NSAIDs and just referred to physio for managment of the PT stregthen etc.
Several surgical approaches are considered when we see these patients who fail orthotic therapy. Subtalar arthroeresis is possible, and is viable in young children. They are reversable and have pretty good success with minimal invasivness. Couple this with a Kidner and possible TAL, and you should do well.
IF the child is a bit on the larger side, and does partake in high contact activity, this may be ill advised.
At that point, I would continue with conservative care, and after the epiphyseal plates have closed, consider the double calcaneal osteotomy consisting of calcaneal slide coupled with an Evans procedure, then add the Kidner and TAL. This is a permanent long term solution, but would reserve it until the child is nearly fully developed ontologically. Heel inversion on toe raise is an excellent sign. You might consider taking some Ischerwood x-ray views to see what the relationship of the calcaneus to the long axis of the tibia is.
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
Os navicularis syndrome vs Post Tib tendon dysfunction
Linear Mode
