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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 This painful condition is called accessory navicular syndrome. Accessory navicular syndrome (ANS) can cause significant pain in the mid-foot and arch, especially with activity.

Redness and swelling may develop over this bony prominence, as well as extreme sensitivity to pressure. Sometimes people may be unable to wear shoes because the area is too sensitive.

Diagnosis To diagnose accessory navicular syndrome, the foot and ankle surgeon will ask about symptoms and examine the foot, looking for skin irritation or s welling. The doctor may press on the bony prominence to assess the area for discomfort. Foot structure, muscle strength, joint motion, and the way the patient walks may also be evaluated.

X-rays are usually ordered to confirm the diagnosis. If there is ongoing pain or inflammation, an MRI or other advanced imaging tests may be used to further evaluate the condition. Non Surgical Treatment The goal of non-surgical treatment for accessory navicular syndrome is to relieve the symptoms. The following may be used. Placing the foot in a cast or removable walking boot allows the affected area to rest and decreases the inflammation. To reduce swelling, a bag of ice covered with a thin towel is applied to the affected area. Do not put ice directly on the skin.

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be prescribed. In some cases, oral or injected steroid medications may be used in combination with immobilization to reduce pain and inflammation. Physical therapy may be prescribed, including exercises and treatments to strengthen the muscles and decrease inflammation. The exercises may also help prevent recurrence of the symptoms. Custom orthotic devices that fit into the shoe provide support for the arch, and may play a role in preventing future symptoms. Even after successful treatment, the symptoms of accessory navicular syndrome sometimes reappear. When this happens, non-surgical approaches are usually repeated.

Surgical Treatment If your pain and discomfort don’t go away with treatments like these, then it may be time to consider surgery. If you decide to go through with it, your surgeon will probably remove the accessory navicular once and for all, and will tighten up the posterior tibial tendon in order to make it better able to support your arch. You’ll probably have to wear a cast for a several weeks, and a brace for some months after that, but with patience, you may be able to say goodbye to your symptoms. Posted by lacikCoach on Jul 18th, 2017 Overview An accessory navicular is an extra bone that is on the inner center arch of the foot. Up to 2.5% of individuals are born with the accessory navicular. Throughout early childhood, this condition is not noticed.

However, in adolescence, when the accessory navicular begins to calcify, the bump on the inner aspect of the arch becomes noticed. For most, it is never symptomatic. However, for some, there is some type of injury, whether a twist, stumble, or fall, that makes the accessory navicular symptomatic. Causes Just having an accessory navicular bone is not necessarily a bad thing. Not all people with these accessory bones have symptoms. Symptoms arise when the accessory navicular is overly large or when an injury disrupts the fibrous tissue between the navicular and the accessory navicular.

A very large accessory navicular can cause a bump on the instep that rubs on your shoe causing pain. Symptoms The main symptom of an aggravated accessory navicular is pain, particularly in the instep. Walking can sometimes be difficult, and tight shoes may worsen the condition. Diagnosis The diagnosis begins with a complete history and physical examination by your surgeon. Usually the condition is suggested by the history and the tenderness over the area of the navicular.

X-rays will usually be required to allow the surgeon see the accessory navicular. Generally no other tests are required. Non Surgical Treatment For less severe symptoms, decreasing or modifying activity, such as avoiding aggravating activities, may suffice. Ice and NSAIDS can be used to help control pain. An arch support or an orthotics may help to stabilize the arch during this time. When rubbing on the bump causes pain, a doughnut pad can be worn.

Exercises to increase range of motion and improve movement should still be used. Surgical Treatment If conservative care does not alleviate the problem then surgical intervention should be considered. The most common procedure for this condition is known as the Kidner procedure where a small incision is made over the navicular bone. The accessory navicular is identified and dissected free from the posterior tibial tendon.

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