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Overview<br>Accessary bone syndrome affects overpronators because of irritation in this area. Improper fitting shoes can also irritate the area. When pain becomes such that it changes running form or becomes intolerable, something needs to be done. Surgery alone without addressing causative factors is useless. Pain returns and new cartilage returns in the tendon, and the inflammation causes pain.<br><br><br><br>Causes<br>Let us see the reasons why the tendon or the bone would get aggravated. Ankle or foot sprain, irritation of the bone caused by footwear, overusing the foot, quite common in athletes and dancers. People born with this extra bone are also known develop flat feet which also adds to the strain on the posterior tibial tendon and lead to the syndrome.<br><br>Symptoms<br>Many people have accessory (?extra?) naviculars (figure 1) - a prominent extra bone extending from the navicular bone. Most accessory naviculars are completely asymptomatic. However, some individuals will develop pain on the inside of their midfoot. Pain may occur from the pressure of the shoe ware against the prominence, irritating either the bone itself or the fibrous junction where the accessory bone meets the regular navicular. Alternatively, the fibrous junction or interface may become painful as a result of tension applied by the posterior tibial tendon through its connection or insertion at that site. Often, individuals will be asymptomatic for years, however, a new pair of shoes or a change in their activity level can cause symptoms. The accessory navicular itself typically develops during adolescence, when the two areas of the navicular bone fail to fuse together.<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://eleonoraesterline.Wordpress.com/2015/06/27/hammer-toe-repair-surgery heel spurs] and plantar fasciitis, it?s important to seek treatment.<br><br>Non Surgical Treatment<br>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 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.<br><br><br><br>Surgical Treatment<br>Depending upon the severity the non operative or conservative treatment should be maintained for at least 4- 6 months before any surgical intervention. There are 2 surgeries that can be performed depending upon the condition and symptoms. First is simple surgical excision. In this generally the accessory navicular along with its prominence is removed. In this procedure, skin incision is made dorsally to the prominence of accessory navicular. Bone is removed to the point where the medial foot has no bony prominence over the navicular, between the head of the talus and first cuneiform. Symptoms are relieved in 90% of cases. Second is Kindler procedure. In this the ossicle and navicular prominence is excised as in simple excision but along with the posterior tibial tendon advancement. Posterior tibial tendon is split and advanced along the medial side of foot to provide support to longitudinal arch. After surgery 4 week short leg cast, well moulded into the arch with the foot plantigrade is applied. Partial weight bearing till the 8th week and later full weight bearing is allowed. When the cast is being removed can start building up the ROM to counter atrophy and other physical therapy treatment which include stretching and strengthening exercises.
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Overview<br>Accessory navicular syndrome occurs when a type II accessory navicular (or "os tibiale externum") becomes painful due to movement across the pseudojoint between the ossicle and the navicular bone. The syndrome presents on MRI with bone marrow oedema signal (hypointense T1, hyperintense T2/STIR) in both the accessory ossicle and navicular. It can be inferred on musculoskeletal ultrasound if a patient's pain is located at a type II accessory navicular and the patient is tender to transducer pressure. Ultrasound can also be useful to compare with the contralateral side.<br><br><br><br>Causes<br>An injury to the fibrous tissue connecting the two bones can cause something similar to a fracture. The injury allows movement to occur between the navicular and the accessory bone and is thought to be the cause of pain. The fibrous tissue is prone to poor healing and may continue to cause pain. Because the posterior tibial tendon attaches to the accessory navicular, it constantly pulls on the bone, creating even more motion between the fragments with each step.<br><br>Symptoms<br>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.<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://Juliana8decker1.exteen.com/20150626/new-hammertoe-surgery heel spurs] and plantar fasciitis, it?s important to seek treatment.<br><br>Non Surgical Treatment<br>Fortunately, surgery is not the only answer when it comes to relieving symptoms of accessory navicular syndrome. The physician may recommend wearing a cast or walking boot for a period of time so the foot can recover from the inflammation. Ice may be used to relieve swelling, too, although it should be wrapped to avoid direct contact with the skin.<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 05:46 12 jun 2017

Overview
Accessory navicular syndrome occurs when a type II accessory navicular (or "os tibiale externum") becomes painful due to movement across the pseudojoint between the ossicle and the navicular bone. The syndrome presents on MRI with bone marrow oedema signal (hypointense T1, hyperintense T2/STIR) in both the accessory ossicle and navicular. It can be inferred on musculoskeletal ultrasound if a patient's pain is located at a type II accessory navicular and the patient is tender to transducer pressure. Ultrasound can also be useful to compare with the contralateral side.



Causes
An injury to the fibrous tissue connecting the two bones can cause something similar to a fracture. The injury allows movement to occur between the navicular and the accessory bone and is thought to be the cause of pain. The fibrous tissue is prone to poor healing and may continue to cause pain. Because the posterior tibial tendon attaches to the accessory navicular, it constantly pulls on the bone, creating even more motion between the fragments with each step.

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
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
Fortunately, surgery is not the only answer when it comes to relieving symptoms of accessory navicular syndrome. The physician may recommend wearing a cast or walking boot for a period of time so the foot can recover from the inflammation. Ice may be used to relieve swelling, too, although it should be wrapped to avoid direct contact with the skin.



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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