Recovery from ruptured ligaments plus accessory navicular syndrome (Read 2973 times)



    I've not been able to run at all since the start of August,  The basic summary is that I twisted my feet in a not very exciting way and they hurt a bit, meaning I couldn't easily weight the left one in particular for a day or so afterwards (but could walk by using the sides of my feet).  After continued pain, especially on the accessory navicular and in the arch, an MRI of the left foot/ankle revealed I had a total rupture of two ligaments (ATFL and CFL) and that I had accessory navicular syndrome.  I was also diagnosed with accessory naviculay syndrome in the right foot.


    I have spent 1 month in an aircast and am now wearing custom orthotics made by the hospital for me to try and help the accessory navicular syndrome.  I don't know whether the ligaments are healing or not as I never had any pain that I could relate directly to them.  However the foot/arch pain from the AN syndrome is still apparent if I don't have my orthotics, if I stand too long or if I even try and run a couple of paces to get across the road.  The aircast did not help the AN syndrome at all as far as pain went, the orthotics have decreased walking and standing pain (I no longer have sharp, burning feelings in my feet, nor dull throbbing), however the AN is still very sore to touch, and if I walk (or stand for too long) either barefoot or not in orthotics the pain returns.


    So, I'm really trying to find ways to maintain/regain some fitness and also to rehab the ankle and feet. 


    The CV options open to me are Mon-Fri the elliptical trainer, exercise bike in the gym and swimming.  Sat-Sun i can use a turbo trainer.  The turbo trainer doesn't cause pain, swimming breast stroke doesn't cause pain.  One issue is that I tried the elliptical for the first time today (using orthotics in my trainers) and I think it may have hurt things as my feet are currently throbbing again, and I was trying to ensure no lifting of my feet whilst on the trainer.  I will see if the same thing happens on Thursday, and if they do the elliptical may be out as well.  Oh dear.


    Also, I have not been referred to a physio for the foot and ankle rehab, so was wondering if you had any tips for rehab of ligament ruptures.  Would heel raises and/or a wobble board be worthwhile?  Has anyone had experience with accessory navicular syndrome and whether any foot exercises can help it?



    I am sadly aware of a massive decrease in my fitness (even with use of the turbo trainer and some swimming) and am also nervous that if I am not careful with my feet that surgery for the AN could be the only remaining option.  I am missing running a lot and found the transition from 25-35 mpw to 0 exceptionally hard.  I now just feel like I will never be fit, nor able to run, again.


    Thanks, sorry for the essay!

     "Don't walk in front of me; I may not follow.  Don't walk behind me; I may not lead.  Just walk beside me and be my friend."

    Old, Slow, Happy

      Hey Hoppity,

      I'm not a doctor and I do not play one on TV.  So..I don't understand all of your issues.  I just wanted to say that I was fighting runners knee for about a year.  If I had taken a little time to heal early on rather than continuing to run in pain, I would have been back on the road sooner.  I continued to run because I was concerned about my fitness.  I had enough pain in my left knee that I was limping and that made my right hip flexor and ITband hurt also.  I am just recommending that you take some time to heal.  Don't do things that hurt.  If your medical advisors know anything about running, listen to them.  In the long run , you'll be glad you did.


      Good Luck!!!



        Hi Richard,


        Thanks for your reply.  Yes, I am definitely keen not to push on through any injuries this time.  In that respect the pain I get from running is good, because it makes the running impossible. Basically if I run more than a few steps I get these hot, shooting pains in my feet and if I continue after that starts the pain becomes so intense that my legs more or less crumple.  I haven't actually been deliberately running, or trying to run, but I get this feeling if I try and run a few steps to cross the road or reach a closing door, and therefore know that actually trying to run would be silly.


        I know that things causing pain should be avoided, but I also don't know how much discomfort is acceptable.  For example the feeling I got after using the elliptical trainer was the throbbing discomfort, rather than intense pain that I cannot cope with.  My feet feel okay again today though.


        Sadly I am not being seen my any clinicians right now as my initial MRI etc were done as a favour through my old job (at an orthopaedic hospital).  I now need to get myself seen by a new specialist in the hope that they can advise.  I'm really just hoping, in the meantime, to find things that I can do, or to get advice on rehab that people have used for dodgy ankles and/or AN syndrome.  For the moment though I think the swimming is the best option...until I manage to get bad knees from swimming breast stroke badly


        Thanks again.  I hope your knee issues are all sorted out now.


        Take care.



         "Don't walk in front of me; I may not follow.  Don't walk behind me; I may not lead.  Just walk beside me and be my friend."

          Hi everyone.

          I know this might seem an odd thing to do, but I thought I would put an update on this thread just in case it was of help to anyone now, or in the future.  

          I didn't do any running until early December.  Until then I was swimming and slowly increasing my time on the elliptical trainer.  For much of October and November my foot was painful to stand on and to walk on.  I wore the orthotics whenever I was in shoes but had more or less constant pain in the arch of my foot.  However the intensity of the pain did ease over time (although some days it felt worse than ever, and these days didn't seem to be related to activity but more to time on my feet).  The  foot would often throb at night.  One thing I did find though was that more or less the only times I was pain free to begin with were when I was barefooted around the house.  If I wore shoes without orthotics (but with some structure to them) my foot hurt more than when I was wearing shoes with orthotics.  

          Throughout this period I really was unable to rest my foot properly.  My job involves lots of standing and walking around, and I also walk to work.  I was walking about 6 miles a day when I was wearing the aircast boot, and immediately upon coming out of that and starting to wear orthotics in my shoes.  In hindsight I think this probably held up the recovery quite a lot, but it was pretty much unavoidable at the time.   

          In early December my foot started to feel a lot better, it still hurt, but wasn't painful to stand on all the time, and it wasn't sore when I used the elliptical.  I very, very tentatively ran about 0.25 miles on the treadmill.  Although I was aware of the foot it didn't hurt, it was just this feeling of slight tenderness.  I then iced the foot, rested it and didn't run again for about 5 days.   I then did a walk run session on flat ground, covering about 2 miles in total.  Again, I was aware of the foot, but didn't suffer any real pain.  

          I continued to walk-run until the end of December, when I finally ran 3 miles in one go.  Since then I have been building my mileage up and making sure I pay attention to my foot.  I have found that my foot has become less and less painful as time has gone on, and I now have very little awareness of the foot.  If I do get a niggle I am always prepared to rest.  I have a turbo trainer than I can use if my foot does become sore, but haven't had to use it since the start of January.

          The main thing that I have done that I feel has allowed me to return to running has been to ignore my previous running pace and to run much, much slower.  I now run 1.5-2 minutes per mile slower than I was running before I got hurt.  I think this has allowed me to increase mileage, but not suffer pain or niggles from the foot itself or from other running muscles/tendons/ligaments.

          I have also been doing heel raises and lots of balancing on tiptoes on my "bad" foot and on the other foot.  I hope that this has helped to strengthen the foot and give me some return of proprioception in the ankle.

          In terms of the ruptured ligaments I did not and have not suffered any obvious pain related to these, so I do not know if I can comment on how well that side of things has healed.

          I still find that my foot is most comfortable when I am not wearing shoes.  However when wearing normal shoes and when in my running shoes, I wear orthotics.  The orthotics do worry me because I think a reliance on a support like that cannot be great for my foot.  This is only my opinion, but I think losing strength in the muscles of the foot and allowing weakening of ligaments and tendons through underuse could, in the longterm do more harm than good.  I have, as a consequence introduced one run a week where I run in fivefingers (I know people will be rolling their eyes at this).  I get no pain during this run nor after it.  I can't comment about whether it is doing harm or good, but as my foot is not any worse for it, I would hope that it is helping it become stronger.

          What do I think about my future in terms of running?  I honestly don't know.  I am taking things one step at a time.  The initial injury occurred after a minor twist.  Another minor incident could bring this back on.  I've not been able to find out much about long term prospects with accessory navicular syndrome and running.  Most of the information I have found seems to suggest that people end up having surgery, as opposed to being able to manage the syndrome non-invasively.  I will see what happens.  However I will be sure to listen to my body and not push it to run or to chase miles.  If I need surgery, but have acted sensibly to prevent it, then I will be content.  Not happy, but content that I did the best I could do delay the operation and resultant recovery period.  I suspect I would then try a slow and steady return to running post-operation.

          Sorry this is long, but I hope it is helpful for someone.  I suppose the key points are that recovery takes quite a long time, when you return to running ease up on the intensity of your runs (I did this in my case my running slower and building mileage gradually), don't push through pain (but equally expect a small amount of awareness), do things to strengthen your feet, and listen to your body.

           "Don't walk in front of me; I may not follow.  Don't walk behind me; I may not lead.  Just walk beside me and be my friend."


            In my opinion you are right on in terms of the foot strengthening through the use of barefoot or FiveFingers runs.  I'm running in Nike Free's right now and am building back up from scratch only running on my toes.  No heel striking.  I also do a bunch of plyometrics in bare feet to keep them strong and limber.

            I eventually want to get some VFFs for running outdoors but it's so dang cold here and I'd rather not get a pair for winter and another for summer.  

            I wish you the best of luck and I think that strengthening your feet is the way to go.  After all, we don't have twenty muscles in the foot just to encase them in an inch of protective cushioning so they can't do anything!

              I'm glad you are getting better.  You are right about taking it slow and strengthening your feet.  I tore a tendon in that same area of the foot.  I was in a similar boot for a month then PT for a month and a few more months of rest.  I took about 6 months off before I started running again although in those months I didn't rest it as well as I should of.  When I started running it didn't hurt while running but certain ways I flexed it would be quiet painful.  After a few months the pain came back during my runs and I would have to take 4-5 days off between runs.  I ran for 7 months like that and it kept getting a little worse after every run until I ended up taking another 5 months off (only swimming).  Now I'm back running for 3 months with a much slower build up and I'm keeping up my PT exercises.  The point of that story is don't rush back.  If I had completely rested and started back slowly, maybe worn the boot longer and take a little more time off, I could of avoided the second 5 month layoff.

              Son, when you participate in sporting events, it's not whether you win or lose; it's how drunk you get. -- Homer Simpson

                Thanks guys.  I certainly hope the foot strengthening is working, it feels like it is. 


                Jason, I did think about Nike Frees and then went for the VFF and barefoot option instead.  As it has been pretty cold here recently I've mainly stuck to the VFFs but will do some more real barefoot stuff when the weather warms up.  I hope if all goes well to be able to transition into running in shoes like the frees, or in racing flats but without orthotics, whilst keeping up some level of barefoot/VFF running.   I will see how that goes though, as, at the moment I am okay with the orthotics plus normal shoe, but it really does mean I have a massive wedge under my heel/arch and it does make heel striking trickier for me to avoid (I know this isn't the case for everyone).


                Protoplasm72, good to know you are back running too.  I definitely agree about taking it slowly on the return to running.  It's so easy to get caught up with really wanting to run and chasing every mile but ignoring the niggles.  I am regularly testing the bits of my foot that used to hurt (for example pressing on the accessory navicular itself, pressing just under it and doing heel raises), if they give any niggles I use it as a warning sign to ease off on something.  Like you, I also think I could have been out of action for less time had I actually rested when the injury was at it's worst.  I was walking 6 miles a day for 3 weeks before I was even put in the boot, I still did some rock climbing, and I wouldn't wear the boot around the house all the time, and, as mentioned I was walking lots immediately after the boot came off.  I guess we live and learn, and I am still learning and I still don't know if this injury will reappear!

                 "Don't walk in front of me; I may not follow.  Don't walk behind me; I may not lead.  Just walk beside me and be my friend."


                  Hi Hoppity I happened to come across this blog and I was interested because I also have ANS and I have not been able to run like I used to.  I hope you are doing better. I wanted to compare our treatments.  Did you ever see a doctor to officially oversee your care? If so did he/she recommend surgery? If not, why?  Also, did you get an "official" MRI if you did see a clinician?  Everything that you had said in your forum is what I am going through only I did not get an MRI. I have no prominence, swelling, or fallen arch.  My foot just hurts and my xrays show ANS.  I tried the walking boot and crutches, the RICE method, naprosyn, and orthotics (not custom ones but I will be getting them soon).  Your reply would be greatly appreciated, as will anyone's who could share his/her experiences.  Especially if you have had the surgery Or have gotten an MRI. Thank you