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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>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>Plain x-rays are used to determine the size of the accessory navicular. There are three main types of accessory navicular bones: a small bone embedded within the nearby posterior tibial tendon; a triangular shaped bone connected to the navicular by thick cartilage; and a large prominent navicular tuberosity thought to represent an accessory navicular that has fused to the navicular. If the status of the posterior tibial tendon needs to be assessed or if other problems are suspected, (ex. Navicular stress fracture) it may be necessary to perform an MRI. Although this is not considered routine, an MRI may be helpful in identifying the degree of irritation. An MRI would demonstrate fluid or edema that may accumulate in the bone as a result of the irritation.<br><br>Non Surgical Treatment<br>In order to strengthen your muscles to prevent further injury and to provide support to the foot, your podiatrist may also outline a physical therapy routine and prescribe orthotics. Orthotics will provide support to the arch of your foot, although they must be carefully crafted in order to make room for that pesky extra bone you?ve got poking about.<br><br><br><br>Surgical Treatment<br>If non-operative treatment fails to relieve the patient’s symptoms, surgical intervention may be warranted. The standard operative treatment of an accessory navicular is a Kidner procedure. However, if surgery is undertaken it is important that it address the underlying source of the patients pain.
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Overview<br>The accessory navicular is an extra piece of cartilage or bone on the inner side of the foot. It is found in about 10 percent of individuals and is present at birth. Many people who have an accessory navicular are never aware of it because they do not experience symptoms. However, aggravation of the accessory navicular or the posterior tibia tendon, which it is attached to, can develop as a result of trauma, irritation from shoes, and excessive overuse.<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>What precipitates the pain? It will usually be caused by rubbing of the skate or other footwear against the prominence. You?ll commonly see blisters or a red irritated area. Other symptoms to look for, especially when you?re treating an older child or adult, include an area of pain along the posterior tibial tendon of the arch and fatigue of the legs. Typically, these patients are not able to participate in sports for a lengthy period of time or you?ll hear them complain of pain and/or soreness after extended activities. Most individuals with a prominent navicular area will have tried accommodating this area with a doughnut pad or adjustments to their skate.<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://rosiasearer.hatenablog.com/entries/2015/06/28 heel spurs] and plantar fasciitis, it?s important to seek treatment.<br><br>Non Surgical Treatment<br>The treatment for a symptomatic accessory navicular can be divided into nonsurgical treatment and surgical treatment. In the vast majority of cases, treatment usually begins with nonsurgical measures such as orthotics, strappings or bracing. Surgery usually is only considered when all nonsurgical measures have failed to control your problem and the pain becomes intolerable.<br><br><br><br>Surgical Treatment<br>If all nonsurgical measures fail and the fragment continues to be painful, surgery may be recommended. The most common procedure used to treat the symptomatic accessory navicular is the Kidner procedure. A small incision is made in the instep of the foot over the accessory navicular. The accessory navicular is then detached from the posterior tibial tendon and removed from the foot. The posterior tibial tendon is reattached to the remaining normal navicular. Following the procedure, the skin incision is closed with stitches, and a bulky bandage and splint are applied to the foot and ankle. You may need to use crutches for several days after surgery. Your stitches will be removed in 10 to 14 days (unless they are the absorbable type, which will not need to be taken out). You should be safe to be released to full activity in about six weeks.

Última revisión de 06:30 12 jun 2017

Overview
The accessory navicular is an extra piece of cartilage or bone on the inner side of the foot. It is found in about 10 percent of individuals and is present at birth. Many people who have an accessory navicular are never aware of it because they do not experience symptoms. However, aggravation of the accessory navicular or the posterior tibia tendon, which it is attached to, can develop as a result of trauma, irritation from shoes, and excessive overuse.



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
What precipitates the pain? It will usually be caused by rubbing of the skate or other footwear against the prominence. You?ll commonly see blisters or a red irritated area. Other symptoms to look for, especially when you?re treating an older child or adult, include an area of pain along the posterior tibial tendon of the arch and fatigue of the legs. Typically, these patients are not able to participate in sports for a lengthy period of time or you?ll hear them complain of pain and/or soreness after extended activities. Most individuals with a prominent navicular area will have tried accommodating this area with a doughnut pad or adjustments to their skate.

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
The treatment for a symptomatic accessory navicular can be divided into nonsurgical treatment and surgical treatment. In the vast majority of cases, treatment usually begins with nonsurgical measures such as orthotics, strappings or bracing. Surgery usually is only considered when all nonsurgical measures have failed to control your problem and the pain becomes intolerable.



Surgical Treatment
If all nonsurgical measures fail and the fragment continues to be painful, surgery may be recommended. The most common procedure used to treat the symptomatic accessory navicular is the Kidner procedure. A small incision is made in the instep of the foot over the accessory navicular. The accessory navicular is then detached from the posterior tibial tendon and removed from the foot. The posterior tibial tendon is reattached to the remaining normal navicular. Following the procedure, the skin incision is closed with stitches, and a bulky bandage and splint are applied to the foot and ankle. You may need to use crutches for several days after surgery. Your stitches will be removed in 10 to 14 days (unless they are the absorbable type, which will not need to be taken out). You should be safe to be released to full activity in about six weeks.