Overview
An accessory navicular bone is a common finding on many foot x-rays. Most accessory naviculars are asymptomatic. However, in some patients the prominent bone on the inside of foot will create discomfort, which leads to difficulty with shoe fitting. Alternatively, the fibrous union between the navicular bone and the ?extra? accessory part may become irritated and cause discomfort. Diagnosis is completed through physical examination and plain x-rays of the foot. Treatment is usually non-operative, often including a change in shoe wear and activity modification. However, patients that have ongoing symptoms once non-surgical treatments are tried, often consider surgery to remove the prominent accessory navicular and, if necessary, reattach the posterior tibial tendon.
Causes
An accessory navicular develops as a result of a congenital anomaly and is found more often in women. If the bone is large, it may rub against a shoe, causing pain. Because of its location, the posterior tibial tendon may pull on the bone during walking or running, causing the fibrous tissue that connects the accessory navicular to the navicular to tear and become inflamed.
Symptoms
Adolescence is a common time for the symptoms to first appear. This is a time when bones are maturing and cartilage is developing into bone. Sometimes, however, the symptoms do not occur until adulthood. The signs and symptoms of accessory navicular syndrome include A visible bony prominence on the midfoot (the inner side of the foot, just above the arch) Redness and swelling of the bony prominence. Vague pain or throbbing in the midfoot and arch, usually occurring during or after periods of activity.
Diagnosis
Plain x-rays are used to determine the size of the accessory navicular. There are three main types of accessory navicular bones: a small bone embedded within the nearby posterior tibial tendon; a triangular shaped bone connected to the navicular by thick cartilage; and a large prominent navicular tuberosity thought to represent an accessory navicular that has fused to the navicular. If the status of the posterior tibial tendon needs to be assessed or if other problems are suspected, (ex. Navicular stress fracture) it may be necessary to perform an MRI. Although this is not considered routine, an MRI may be helpful in identifying the degree of irritation. An MRI would demonstrate fluid or edema that may accumulate in the bone as a result of the irritation.
Non Surgical Treatment
Although operative treatment, and removal of the accessory navicular is possible, this is not usually indicated at first. Conservative nonoperative treatment is best, the course depending on the severity of the symptoms. When the pain is very severe, which could indicate a fracture, a period of immobilization might be required. This is done by waring a fracture boot, or a cast, which How can we increase our height? help the ossicle stay stable, aiding in healing. Immobilization usually lasts between 4 to 6 weeks. Afterwards, physical therapy exercise, or any appropriate home course, should be used to help strengthen the ankle and return the ankle and foot to full range of motion, and have no pain on movement. Sometimes crutches are used when weight bearing is too painful, but it is best to try to bear weight when possible.
Surgical Treatment
The Kidner procedure involves resecting the prominent accessory navicular and ensuring that the posterior tibial tendon is still attached to the bone. Often the prominent bone can simply be shelled out from its position relative to the posterior tibial tendon, which leaves the tendon intact. However, if the tendon is loose and floppy once the extra bone has been removed, suturing or tother is required as a means of attaching it into the remaining navicular bone.
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An accessory navicular bone is a common finding on many foot x-rays. Most accessory naviculars are asymptomatic. However, in some patients the prominent bone on the inside of foot will create discomfort, which leads to difficulty with shoe fitting. Alternatively, the fibrous union between the navicular bone and the ?extra? accessory part may become irritated and cause discomfort. Diagnosis is completed through physical examination and plain x-rays of the foot. Treatment is usually non-operative, often including a change in shoe wear and activity modification. However, patients that have ongoing symptoms once non-surgical treatments are tried, often consider surgery to remove the prominent accessory navicular and, if necessary, reattach the posterior tibial tendon.
Causes
An accessory navicular develops as a result of a congenital anomaly and is found more often in women. If the bone is large, it may rub against a shoe, causing pain. Because of its location, the posterior tibial tendon may pull on the bone during walking or running, causing the fibrous tissue that connects the accessory navicular to the navicular to tear and become inflamed.
Symptoms
Adolescence is a common time for the symptoms to first appear. This is a time when bones are maturing and cartilage is developing into bone. Sometimes, however, the symptoms do not occur until adulthood. The signs and symptoms of accessory navicular syndrome include A visible bony prominence on the midfoot (the inner side of the foot, just above the arch) Redness and swelling of the bony prominence. Vague pain or throbbing in the midfoot and arch, usually occurring during or after periods of activity.
Diagnosis
Plain x-rays are used to determine the size of the accessory navicular. There are three main types of accessory navicular bones: a small bone embedded within the nearby posterior tibial tendon; a triangular shaped bone connected to the navicular by thick cartilage; and a large prominent navicular tuberosity thought to represent an accessory navicular that has fused to the navicular. If the status of the posterior tibial tendon needs to be assessed or if other problems are suspected, (ex. Navicular stress fracture) it may be necessary to perform an MRI. Although this is not considered routine, an MRI may be helpful in identifying the degree of irritation. An MRI would demonstrate fluid or edema that may accumulate in the bone as a result of the irritation.
Non Surgical Treatment
Although operative treatment, and removal of the accessory navicular is possible, this is not usually indicated at first. Conservative nonoperative treatment is best, the course depending on the severity of the symptoms. When the pain is very severe, which could indicate a fracture, a period of immobilization might be required. This is done by waring a fracture boot, or a cast, which How can we increase our height? help the ossicle stay stable, aiding in healing. Immobilization usually lasts between 4 to 6 weeks. Afterwards, physical therapy exercise, or any appropriate home course, should be used to help strengthen the ankle and return the ankle and foot to full range of motion, and have no pain on movement. Sometimes crutches are used when weight bearing is too painful, but it is best to try to bear weight when possible.
Surgical Treatment
The Kidner procedure involves resecting the prominent accessory navicular and ensuring that the posterior tibial tendon is still attached to the bone. Often the prominent bone can simply be shelled out from its position relative to the posterior tibial tendon, which leaves the tendon intact. However, if the tendon is loose and floppy once the extra bone has been removed, suturing or tother is required as a means of attaching it into the remaining navicular bone.
Th1s1sanart1cl3s1te
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