A sprinter with arch pain. Kohlers AVN: Not everything is always mechanically pain driven.
More ankle rocker is not always the right answer. An orthotic or stability shoe is not always the answer.
Thus, not everything will have a mechanical solution and a corrective exercise. People without a medical background will not likely know what Kohlers Disease is or Mueller Weiss syndrome is for that matter (the adult form of AVN (avascular necrosis)).
So, an athlete coming to you with pain in the arch, you as a trainer, coach, and maybe even a therapist or doctor for that matter, might easily think: "impaired ankle rocker", too much pronation, wrong shoe fit, etc . . . , . the list can be very long.
But sometimes, the problem is unrelated, or indirectly related. This case of Kohlers/Mueller Weiss came in this week from out of state in a sprinter. The pain started with a shoe change, and some pain in the arch region, dorsally in this case. Could it just be a massive stress response?, but it also could be Kohlers. Time will tell, but as you can see, the STIR sequence MRI shows a MASSIVE inflammatory response in the navicular bone. And if it is Kohlers AVN, we are in the early inflammatory stage. You must catch this in the early stage, and try to not let it progress to avascular stage and necrosis and collapse. That means utmost protection, taht means 100% non weight bearing. If you break through the cortex, and this is early AVN, a deformed collapsed navicular will result, and that *could mean foot pain for life. Certainly impaired foot biomechanics.
Don't dismiss unchanging pain, or worsening pain. Sometimes it is not mechanical. This case remains unknown right now, meaning massive stress response (ie pre stress fracture)? or AVN early stange? I am not taking a chance, bag it up and reimage several weeks later. Over treat this one, just in case.
Shawn Allen, the other gait guy
#AVN, #Kohlers, #Muellerweiss, #osteonecrosis, #sprinter, #archpain, #gait, #gaitproblems
