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A 10-year-old boy presents with medial foot pain that is severe enough that it limits his daily activities such as walking to school. Physical exam shows tenderness in the medial forefoot 3 cm anterior and inferior to the medial malleolus. A radiograph is shown in Figure A. Nonoperative treatment including orthotics and cast immobilization was attempted for three months without success. What is the most appropriate next step in treatment?
No treatment needed-return to class
Continue serial casting
Excision of the medial prominence of the navicular, including the synchondrosis
ORIF of the navicular non-union
Bone stimulator for the navicular non-union
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An 18-year-old male complains of a painful prominence over his medial midfoot for the past 2 years; NSAIDs and orthotics have failed to provide relief. Physical exam demonstrates a firm, nonmobile, tender bump on the medial midfoot with no skin changes. A radiograph is provided in figure A. Which of the following is the best treatment option?
Total contact cast
MRI of the foot and chest CT scan