Our patient, in this case study, is a teenage female soccer player with a painful Accessory Navicular Syndrome. She is being treated initially with conservative measures , and in a few weeks time her symptoms have been controlled. The treatment goals now shift to maintaining the control of her condition, long term, and allow her to successfully pursue her career in soccer. The approach is to maintain the proper muscle strength and flexibility in her legs and feet, selecting the best shoe for her and building a custom foot orthotic to directly address the underlying biomechanical etiology of her condition.
Guidance towards the orthotic selection process can be found on the KevinRoot Medical website. Three different suggested models come to mind that may best suit the needs of this particular patient. Model P10 for Pediatric Flatfoot, Model P12 for Pes Planus and Model S7 which is our suggested model for soccer players.All models feature a blanched forefoot to rearfoot correction. P10 features a medial and lateral flange to assist in controlling excessive transverse plane motion often present in pliable pediatric feet as well as limiting heel eversion. It is a full length device with a vinyl top cover to the toes. Model P10 features only a medial flange, but has a deeper heel cup at 18 mm as well as a flexible frame filler reinforcement.It is also a full length device with a .75 mm Protex cover. Model S7 is our suggested device for use in soccer. It features a thinner frame, which allows more flexibility and support when changing direction and allows agility. It has a shallow heel cup of 6 mm and an intrinsic rearfoot correction to sit lower in a soccer cleat with limited space. Another unique feature is a 1st ray cutout to promote 1st ray excursion when dribbling the ball and kicking.
A good rule to follow, when possible, when working with a serious athlete, such as this young lady who aspires to play college soccer on scholarship is to have an orthotic device that will optimize performance in that given sport. It behooves the clinician to have some level of knowledge of the sport. Soccer is generally played on turf, in a low supportive and lightweight cleat. Dribbling and kicking are two aspects of soccer generally not present in other sports.It can also be a high contact sport, with a high incidence of sprains, muscle pulls, bruises, stress fractures and osteochondral injuries in younger athletes.
My recommendation to this patient and her mother is to focus on keeping her performing at a high level on the soccer pitch. A neutral position scan of her feet with a marker placed at the Navicular Tuberosity. An S7 Model with intrinsic rearfoot post should suffice in a case with mild to moderate pronation, if more control is needed then can use a deeper heel cup or add a medial skive to the heel cup. The arch height should be maintained but a button is added to the prominent Navicular area. No frame filler in order to limit weight of the device and a thin, yet padded top cover. It would be beneficial to have the patient provide the preferred shoe/cleat, and include a photo of the sock liner with a ruler in order to increase accuracy of the extension of the orthotic device. Additionally, one could consider using a carbon graphite frame if more rigidity but less volume of the device is desired.
The patient should be encouraged to consider her new orthotics as a very necessary part of her soccer equipment, and should be dedicated for use in soccer only. Another highly effective orthotic device could be made from the same impressions that would be more versatile and appropriate for everyday use. In this case I would favor a P12 type device over the P10, which would be also customized for this individual patient.
