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Overview<br>Some people, possibly beginning in early adolescents, but perhaps later, can develop a painful bump on the side of their foot. The pain may be worse after athletic activity or just normal walking, and walking itself may become painful. This pain may become constant, but it will tend to improve with continued rest. Depending on the size of the bump, it may rub against shoes, or cause pain if the bump is hit by something. Over time, the arch of the foot may be lost and a flat food will develop.<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>An initial assessment is an orthopaedic office begins with a thorough history and complete physical exam, including an assessment of the posterior tibial tendon and areas of tenderness. Associated misalignments of the ankle and foot should be noted. Finally, weight-bearing x-rays of the foot will help in making the diagnosis. Sometimes, an MRI may be needed to see if the posterior tibial tendon is involved with the symptoms or getting more clarity on the anatomy of the accessory navicular.<br><br>Non Surgical Treatment<br>Using PRP treatments, orthotics, proper local running store shoes and physical therapy should do the trick. No long recovery, no long down time. My runners and athletes are usually back to their sport pain free within a month. The key is eliminating the syndrome, not the bone (or cartilage).<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>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>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>Possible symptoms of accessory navicular syndrome include redness or swelling in the area of the accessory navicular, and pain that is present around the middle of the foot around the arch. Discomfort is most often present following periods of exercise or prolonged walking or standing. The bone may be somewhat visible on the inside of the foot above the arch. Most symptoms of accessory navicular syndrome first appear in childhood around the time of adolescence as the bones are still growing and developing. For some with an accessory navicular, though, symptoms may not appear until entering 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://nullghoul4788.soup.io/post/594536594/none heel spurs] and plantar fasciitis, it?s important to seek treatment.<br><br>Non Surgical Treatment<br>Ideally, getting rid of the symptoms of accessory navicular syndrome will involve soothing the inflammation and irritation in your foot. So, for starters, your podiatrist may have you rest the area, allowing the inflamed tendon and bone to heal. This may be accomplished by wearing a cast or boot designed to keep you from moving the problem area. Your podiatrist may also suggest using ice to reduce the swelling and inflammation, and anti-inflammatory medications (like ibuprofen, or sometimes a cortisone shot or other steroid medication).<br><br><br><br>Surgical Treatment<br>rolotherapy Strengthens the ligaments, tendons and muscle attachments affected by ANS. Prolotherapy is an injection technique that works to strengthen these ligament, tendon, and muscle attachments by causing a mild anti-inflammatory response in the tissues. Prolotherapy supports the body’s normal healing response to injury. The solution directed at the injured and weakened tissue will cause an influx of blood supply and regenerative cells to come to the area. As part of this healing cascade, collagen cells will also be deposited at the injured site. The tissue, which is made mostly of collagen, will become stronger and tighter as these new collagen cells mature. The injured tissue becomes healthy again. When the weakness or injury in these structures is resolved, often times the symptoms with ANS are resolved and the patient no longer suffers from chronic foot pain. In our experience, patients typically feel better soon after treatment. However, if the person desires to run again or continue to be very active, it may take 3-5 treatments to fully resolve the condition. Activity is increased during treatment as symptoms resolve.

Última revisión de 20:11 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
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
Possible symptoms of accessory navicular syndrome include redness or swelling in the area of the accessory navicular, and pain that is present around the middle of the foot around the arch. Discomfort is most often present following periods of exercise or prolonged walking or standing. The bone may be somewhat visible on the inside of the foot above the arch. Most symptoms of accessory navicular syndrome first appear in childhood around the time of adolescence as the bones are still growing and developing. For some with an accessory navicular, though, symptoms may not appear until entering 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
Ideally, getting rid of the symptoms of accessory navicular syndrome will involve soothing the inflammation and irritation in your foot. So, for starters, your podiatrist may have you rest the area, allowing the inflamed tendon and bone to heal. This may be accomplished by wearing a cast or boot designed to keep you from moving the problem area. Your podiatrist may also suggest using ice to reduce the swelling and inflammation, and anti-inflammatory medications (like ibuprofen, or sometimes a cortisone shot or other steroid medication).



Surgical Treatment
rolotherapy Strengthens the ligaments, tendons and muscle attachments affected by ANS. Prolotherapy is an injection technique that works to strengthen these ligament, tendon, and muscle attachments by causing a mild anti-inflammatory response in the tissues. Prolotherapy supports the body’s normal healing response to injury. The solution directed at the injured and weakened tissue will cause an influx of blood supply and regenerative cells to come to the area. As part of this healing cascade, collagen cells will also be deposited at the injured site. The tissue, which is made mostly of collagen, will become stronger and tighter as these new collagen cells mature. The injured tissue becomes healthy again. When the weakness or injury in these structures is resolved, often times the symptoms with ANS are resolved and the patient no longer suffers from chronic foot pain. In our experience, patients typically feel better soon after treatment. However, if the person desires to run again or continue to be very active, it may take 3-5 treatments to fully resolve the condition. Activity is increased during treatment as symptoms resolve.

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