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Overview<br>Os tibiale navicular refers to an extra bone found in the foot. An accessory bone is a bone that is not normally found in the average human, but in most cases is not considered abnormal. This condition represents a secondary ossification center (growth center) of the navicular bone. It is present from birth. The navicular bone is found on the inside part of the foot.<br><br><br><br>Causes<br>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.<br><br>Symptoms<br>Many people with an accessory navicular do not experience symptoms, however some may notice a bump and/or swelling on the inside of the foot just above the arch. They may also experience pain in the middle of the foot, particularly with physical activity.<br><br>Diagnosis<br>To diagnose accessory navicular syndrome, medical staff ask about the patient?s activities and symptoms. They will examine the foot for irritation or swelling. Medical staff  evaluate the bone structure, muscle, joint motion, and the patient?s gait. X-rays can usually confirm the diagnosis. MRI or other imaging tests may be used to determine any irritation or damage to soft-tissue structures such as tendons or ligaments. Because navicular accessory bone irritation can lead to bunions, [http://janicekarolyn.bravesites.com heel spurs] and plantar fasciitis, it?s important to seek treatment.<br><br>Non Surgical Treatment<br>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. 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 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.<br><br><br><br>Surgical Treatment<br>For patients who have failed conservative care or who have had recurrent symptoms, surgery can be considered. Surgical intervention requires an excision of the accessory navicular and reattachment of the posterior tibial tendon to the navicular. Often times, this is the only procedure necessary. However, if there are other deformities such as a flat foot or forefoot that is abducted, other procedures may be required.
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Overview<br>An accessory navicular is a fairly uncommon condition which is rarely symptomatic. Oftentimes non-surgical treatment is successful. In the minority of cases, surgical intervention is required. Patients typically do very well with conservative and surgical treatment. Athletic activities can usually be restarted once symptoms have improved or the patient has recovered from surgery.<br><br><br><br>Causes<br>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.<br><br>Symptoms<br>The majority of people with an accessory navicular experience no symptoms, since, for the most part, the little extra bone simply isn?t large enough to cause problems. Unfortunately, some people lose on ?accessory navicular roulette,? and the bone begins to mess things up with the foot. These problems usually show up sometime in adolescence, when bones and cartilage in the body are settling into their final shapes (although occasionally people make it all the way through childhood, only to start experiencing discomfort and pain in adulthood).<br><br>Diagnosis<br>To diagnose accessory navicular syndrome, medical staff ask about the patient?s activities and symptoms. They will examine the foot for irritation or swelling. Medical staff  evaluate the bone structure, muscle, joint motion, and the patient?s gait. X-rays can usually confirm the diagnosis. MRI or other imaging tests may be used to determine any irritation or damage to soft-tissue structures such as tendons or ligaments. Because navicular accessory bone irritation can lead to bunions, [http://matildedeluise.Exteen.com/20150628/hammer-toe-relief-free-of-surgery heel spurs] and plantar fasciitis, it?s important to seek treatment.<br><br>Non Surgical Treatment<br>Treatment of the accessory navicular begins with rest, which may include activity modification or temporary immobilization in a boot or a brace. Once the inflammation subsides the foot needs to be supported. The support consists of a specially designed orthotic arch support. Occasionally, the orthotic will dig into the edge of the accessory navicular bone under the arch of the foot. This is very uncomfortable. For this reason the orthotic support needs to be carefully made. The orthotic support will help control (but not cure) the flat foot and will often decrease the inflammation on the navicular.<br><br><br><br>Surgical Treatment<br>In the original Kidner procedure, the entire posterior tibial tendon was released from the navicular and then rerouted through a drill hole placed through the navicular. The original Kidner procedure is now rarely used as a means of treating an isolated accessory navicular. Instead, a modification of the Kidner procedure has become more commonplace.  The modified Kidner procedure consists of carefully removing the accessory and anchoring the posterior tibial tendon to the surface of the navicular where the accessory was removed. The repair may be done by passing a suture through the tendon and then through drill holes in the navicular, or by using a suture anchor.

Revisión de 18:08 11 jun 2017

Overview
An accessory navicular is a fairly uncommon condition which is rarely symptomatic. Oftentimes non-surgical treatment is successful. In the minority of cases, surgical intervention is required. Patients typically do very well with conservative and surgical treatment. Athletic activities can usually be restarted once symptoms have improved or the patient has recovered from surgery.



Causes
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.

Symptoms
The majority of people with an accessory navicular experience no symptoms, since, for the most part, the little extra bone simply isn?t large enough to cause problems. Unfortunately, some people lose on ?accessory navicular roulette,? and the bone begins to mess things up with the foot. These problems usually show up sometime in adolescence, when bones and cartilage in the body are settling into their final shapes (although occasionally people make it all the way through childhood, only to start experiencing discomfort and pain in adulthood).

Diagnosis
To diagnose accessory navicular syndrome, medical staff ask about the patient?s activities and symptoms. They will examine the foot for irritation or swelling. Medical staff evaluate the bone structure, muscle, joint motion, and the patient?s gait. X-rays can usually confirm the diagnosis. MRI or other imaging tests may be used to determine any irritation or damage to soft-tissue structures such as tendons or ligaments. Because navicular accessory bone irritation can lead to bunions, heel spurs and plantar fasciitis, it?s important to seek treatment.

Non Surgical Treatment
Treatment of the accessory navicular begins with rest, which may include activity modification or temporary immobilization in a boot or a brace. Once the inflammation subsides the foot needs to be supported. The support consists of a specially designed orthotic arch support. Occasionally, the orthotic will dig into the edge of the accessory navicular bone under the arch of the foot. This is very uncomfortable. For this reason the orthotic support needs to be carefully made. The orthotic support will help control (but not cure) the flat foot and will often decrease the inflammation on the navicular.



Surgical Treatment
In the original Kidner procedure, the entire posterior tibial tendon was released from the navicular and then rerouted through a drill hole placed through the navicular. The original Kidner procedure is now rarely used as a means of treating an isolated accessory navicular. Instead, a modification of the Kidner procedure has become more commonplace. The modified Kidner procedure consists of carefully removing the accessory and anchoring the posterior tibial tendon to the surface of the navicular where the accessory was removed. The repair may be done by passing a suture through the tendon and then through drill holes in the navicular, or by using a suture anchor.

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