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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 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>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, [https://juliannemoeller.wordpress.com/2015/06/25/recovery-after-bunion-hammer-toe-surgery heel spurs] and plantar fasciitis, it?s important to seek treatment.<br><br>Non Surgical Treatment<br>Aside from surgery, there are a few options for handling an accessory navicular bone that has become symptomatic. This includes immobilization, icing, medicating, physical therapy, and orthotic devices. Immobilizing involves placing the foot and ankle in a cast or removable walking boot. This alleviates stressors on the foot and can decrease inflammation. Icing will help reduce swelling and inflammation. Medication involves usage of nonsteroidal anti-inflammatory drugs, or steroids (taken orally or injected) to decrease inflammation. Physical therapy can be prescribed in order to strengthen the muscles and help decrease inflammation. Physical therapy can also help prevent the symptoms from returning. Orthotic devices (arch support devices that fit in a shoe) can help prevent future symptoms. Occasionally, the orthotic device will dig into the edge of the accessory navicular and cause discomfort. For this reason, the orthotic devices made for the patient should be carefully constructed.<br><br><br><br>Surgical Treatment<br>Once the navicular inflammation has lessened it is not necessary to perform surgery unless the foot becomes progressively flatter or continues to be painful. For these children, surgery can completely correct the problem by removing the accessory navicular bone and tightening up the posterior tibial tendon that attaches to the navicular bone. The strength of this tendon is integral to the success of this surgery as well as the arch of the foot. Following surgery the child is able to begin walking on the foot (in a cast) at approximately two weeks. The cast is worn for an additional four weeks. A small soft ankle support brace is then put into the shoe and worn with activities and exercise for a further two months.
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Overview<br>As many as 14% of people have an ?accessory? or extra bone or piece of cartilage on the inner side of the foot. An accessory navicular is an inborn condition that affects only a minority of the population. It is not part of normal bone structure and therefore is not present in most people. It may be found when the foot is x-rayed for other reasons, or when irritation develops. Patients may not be aware of it until a change in their activity, growth spurt or new footwear creates friction. Most cases of accessory navicular syndrome are treated conservatively.<br><br><br><br>Causes<br>Accessory navicular syndrome as it is called can result from a number of causes, excess or overuse syndrome as seen in an athlete. Trauma to the foot as in an ankle sprain or direct trauma to the navicular bone. chronic irritation from shoes rubbing against the extra bone, over time, may cause pain. Excessive pronation which strains the attachment of tibialis posterior muscles into the navicular bone. Keep in mind, the larger the actual accessory bone, the greater the chance of it becoming an issue.<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://roomyoffice5086.jimdo.com/2015/06/27/hammer-toe-caused-by-plantar-fasciitis 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>In my experience, the Modified Kidner procedure is one of the most reliable operations for reducing arch pain associated with an accessory navicular bone (a.k.a. os tibial externum). You can also use this procedure to treat a prominence at the inner aspect of the arch, which has been caused by an enlarged navicular bone. The most common patients to visit our office with these problems are between the ages of 8 and 15 and are involved in activities like ice skating, ballet and soccer.

Revisión de 14:31 11 jun 2017

Overview
As many as 14% of people have an ?accessory? or extra bone or piece of cartilage on the inner side of the foot. An accessory navicular is an inborn condition that affects only a minority of the population. It is not part of normal bone structure and therefore is not present in most people. It may be found when the foot is x-rayed for other reasons, or when irritation develops. Patients may not be aware of it until a change in their activity, growth spurt or new footwear creates friction. Most cases of accessory navicular syndrome are treated conservatively.



Causes
Accessory navicular syndrome as it is called can result from a number of causes, excess or overuse syndrome as seen in an athlete. Trauma to the foot as in an ankle sprain or direct trauma to the navicular bone. chronic irritation from shoes rubbing against the extra bone, over time, may cause pain. Excessive pronation which strains the attachment of tibialis posterior muscles into the navicular bone. Keep in mind, the larger the actual accessory bone, the greater the chance of it becoming an issue.

Symptoms
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.

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
In my experience, the Modified Kidner procedure is one of the most reliable operations for reducing arch pain associated with an accessory navicular bone (a.k.a. os tibial externum). You can also use this procedure to treat a prominence at the inner aspect of the arch, which has been caused by an enlarged navicular bone. The most common patients to visit our office with these problems are between the ages of 8 and 15 and are involved in activities like ice skating, ballet and soccer.