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insertional tendonitis, accessory navicular, or both


Severe pain in ankles after walking 6 or 8 blocks which gets worse the more I walk.
The pain is mostly on the inside of the ankle directly in front of the ankle bone.
I also get pain in the plantar fascia region but not as incapacitating nor as frequent.
I had a fairly rigid orthotic made which didn’t help me at all and seems to irritate the condition.
Right now I’m best in Teva Sandals.
I’ve essentially had two differenct diagnoses, one from a respected Foot and Ankle Orthopedist and the other from a very well respected Podiatrist.
The Orthopedist says I have an accessory navicular bone in both feet and recommened extensive ankle stregthening exercises and NO orthotics.
The Podiatrist, who I feel better about, says I have an insertional tendonitis of the anterior tibial tendon and that this tendon goes all the way around under the planta fascia and that’s why I’m having pain there as well.
He says I should do NO exercises that push the foot toward me and extensive stretching of the calf.
Although he would prefer a rigid orthotic, recognizing I can’t wear it, he will make me a “soft” orthotic.My real concern is who to trust because the PT recommendations are very different.And most urgently, how do I walk without irritating the anterior tibial tendon to the point where I cannot walk?
Thanks and I apologize for the length of this post. T


  1. I had the exact same problem as you and it was getting tp the point where at times i could not even walk.the area of my foot was so swallon it looked bigger then my ancle.I ended up in a cast and a walking boot and neither of them helped.I had surgery 2 months ago which seemed to have help but i am still in a walking boot, the area is still a little swallon but doctor said that it will take a long time to heal being that he removes the accessory navcular bone and any tendon surrounding it.

  2. The most likely case is a posterior tibial tendonitis and accessory navicular. Sometimes the accessory navicular can get irritated or even fractured as it’s connection to the main navicular is either fibrous, cartilaginous or bony. Sometimes a rigid orthotic is best. Sometimes surgery is best. It depends on many factors. When there is a significan amount of pronation, I have successfully used on occasion an AFO (Richie brace) for this. Has anyone recommended a MRI or diagnostic ultrasound?

    • Thanks for your suggestions. Neither the podiatrist (out of network), or the orthopedist (in network), have recommended either procedure you suggest. In fact, the orthopedist only wanted to xray one ankle although I had problems with both; when I strongly protested, both were xrayed.When I return to the orthopedist, essentially unchanged, I’ll suggest that I have one or the other procedure and see what happens.What is an AFO Richie brace and where might I find one?Thanks again.Louise