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What is the Accessory Navicular?
The accessory navicular (os navicularum or os tibiale externum) is an extra bone or piece of cartilage located on the inner side of the foot just above the arch. It is incorporated within the posterior tibial tendon, which attaches in this area.
An accessory navicular is congenital (present at birth). It is not part of normal bone structure and therefore is not present in most people.
What is Accessory Navicular Syndrome?
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
- Excessive activity or overuse
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.
Signs and Symptoms of Accessory Navicular Syndrome
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
To diagnose accessory navicular syndrome, the foot and ankle surgeon will ask about symptoms and examine the foot, looking for skin irritation or swelling. 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.
Treatment: Non-Surgical Approaches
The goal of non-surgical treatment for accessory navicular syndrome is to relieve the symptoms. The following may be used:
- Immobilization. Placing the foot in a cast or removable walking boot allows the affected area to rest and decreases the inflammation.
- Ice. 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.
- Medications. Oral 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. 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.
- Orthotic devices. 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.
When Is Surgery Needed?
If non-surgical treatment fails to relieve the symptoms of accessory navicular syndrome, surgery may be appropriate. Surgery may involve removing the accessory bone, reshaping the area, and repairing the posterior tibial tendon to improve its function. This extra bone is not needed for normal foot function.
UPDATE 3/23/20: In attempt to maintain the safety of our patients, employees, and the community, the office is physically closed, other than for the care of patients with urgent concerns / emergenices only. Attempts will be made to return phone calls Monday through Thursday from 9AM to 1PM. Please use the "Request an Appointment" resource above to request an appointment. If an established patient, we encourage you to log into the Patient Portal and send a message to Dr. Barnes or the office with any questions or concerns. Thank you.
TeleHealth and Tele-Visits in the time of COVID-19
Step Ahead Foot & Ankle Clinic, PC has initiated a TeleHealth Service during the COVID-19 Pandemic for a number of reasons:
1.) Our top priority has always been, and continues to be, Patient, Employee, Community Health and Safety.
2.) With the primary goal of triaging, or prioritizing what's urgent and what's not, Dr. Barnes seeks to help patients with the foot concerns over the phone or computer. Caring for patients in this way, and arranging for visits in clinic if necessary (infections, ulcerations, injuries) and in a controlled environment, she hopes to do her part in allowing to the Urgent Cares and Emergencies Rooms help those with needs related to the virus.
3.) Although Dr. Barnes obviously cannot physicially treat you or other patients over the phone or computer, she can hopefully see if your concern would be best treated physically, and arrange for this to be done. If she can help give you direction and advice over the computer or phone, she will do so. This particularly applies to you if you have foot pain, as many treatment options can be relayed in this way (stretches, shoe recommendations, orthotic recommendations).
4.) During this time of anxiety, stress, and uncertainty, Dr. Barnes wants to do her part in helping you do the things you need to do (caring for a loved one, running outside for stress relief, or walking on a treadmill at home, for example) without foot pain interfering. She does't want you to have to wait months or an indefinite period of time for you to get back on your feet! "CLICK HERE TO REQUEST A TELEVISIT."