Overview People who have an accessory navicular often are unaware of the condition if it causes no p...

1. Removal Of Accessory Navicular Bone Recovery
Overview
People who have an accessory navicular often are unaware of the condition if it causes no problems.
However, some people with this extra bone develop a painful condition known as accessory navicular
syndrome when the bone and/or posterior tibial tendon are aggravated. This can result from any of
the following, trauma, as in a foot or ankle sprain, chronic irritation from shoes or other footwear
rubbing against the extra bone. Many people with accessory navicular syndrome also have flat feet
(fallen arches). Having a flat foot puts more strain on the posterior tibial tendon, which can produce
inflammation or irritation of the accessory navicular.
Causes
Accessory navicular syndrome as it is called can result from a
number of causes, excess or overuse syndrome as seen in an
athlete. Trauma to the foot as in an ankle sprain or direct
trauma to the navicular bone. chronic irritation from shoes
rubbing against the extra bone, over time, may cause pain.
Excessive pronation which strains the attachment of tibialis
posterior muscles into the navicular bone. Keep in mind, the
larger the actual accessory bone, the greater the chance of it
becoming an issue.
Symptoms
One obvious problem with the accessory navicular is that it
may be large and stick out from the inside of the foot. This
can cause it to rub against shoes and so become quite painful. The fibrous connection between the
accessory navicular and the navicualar, as well, is easy to injure, also leading to pain. This is kind of
like a fracture, and such injuries cause the bone to move around too easily, leading to pain with
activity. When the connection between the bones is injured in this way, the two bones do not always
heal properly, so pain may continue unabated.
Diagnosis
Diagnosis starts by speaking with the patient about symptoms. The physician will look at the foot
and examine it for signs of an accessory navicular. By putting pressure on the area, the doctor may
determine its presence simply by the presence of pain. The muscle, joint, and the overall structure of
the foot may be considered, as well as the way in which the patient walks. If a diagnosis of accessory
navicular syndrome is made, an X-ray or MRI may be ordered to confirm diagnosis.
Non Surgical Treatment
Initial treatment is conservative. With the first episode of symptoms, a medial heel wedge, anti-
inflammatories, and physical therapy can be helpful. If very painful, a cast or boot may be needed for
a short period time before the wedge and physical therapy can be initiated. Very rarely is a steroid
injection warranted or recommended. As the pain improves, patients can resume activities. For a

2. minority of patients, an arch support or custom orthotic can help to take some of the extra pressure
off of the accessory navicular and the posterior tibial tendon.
Surgical Treatment
Fusion of the accessory navicular to the navicular with screws
is required when there is a large accessory navicular bone
and removal of this bone would reduce the articular surface of
the Navicular to the talus (coxa pedis). Fusion will relieve
pain without disrupting the tibialis posterior tendon insertion
nor narrowing talar head support. In most instances, a
patient’s recovery will be as follows. 0-6 weeks:
Immobilization (in case or cast boot) non-weight-bearing or
touch weight-bearing. 6-10 weeks: Increasing activity in a
cast boot. Physical therapy to work on strength and balance.
Full recovery after 9 weeks-2 months. In some patients
(where the posterior tibial tendon is still intact and
functioning) the treating surgeon may allow weight-bearing as
tolerated in a cast boot immediately after surgery.