Diferencia entre revisiones de «Physical Therapy For Accessory Navicular Syndrome»

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Overview<br>The human body is rarely the same from person to person. Some things stay the same, like the function of the internal organs. Even when structures are similar, however, little variations, like extra bone tissue, can make a significant difference in the body. Having small, extra bones is not as uncommon as you might think. Sometimes, though, these additional tissues can cause painful problems, as with accessory navicular syndrome.<br><br><br><br>Causes<br>Like all painful conditions, ANS has a root cause. The cause could be the accessory navicular bone itself producing irritation from shoes or too much activity. Often, however, it is related to injury of one of the structures that attach to the navicular bone. Structures that attach to the navicular bone include abductor hallucis muscle, plantar calcaneonavicular ligament (spring ligament) parts of the deltoid ligament, posterior tibial tendon.<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://nenitaciborowski.hatenablog.com/entry/2015/06/21/160325 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. Placing the foot in a cast or removable walking boot allows the affected area to rest and decreases the inflammation. 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. 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>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>There are three different types of accessory navicular. This extra cartilage, which is turned into bone, is found attached to the posterior tibial tendon, just medial (inside) the navicular bone. The accessory navicular can affect the insertion of the posterior tibial tendon. This tendon has a job of keeping your foot aligned and helping to maintain an arch. The accessory navicular can be associated with a normal foot posture and alignment, or sometime with a flat (pes planus) foot.<br><br><br><br>Causes<br>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. Many people with accessory navicular syndrome also have flat feet (fallen arches). Having a flat foot puts more strain on the posterior tibial tendon, which can produce inflammation or irritation of the accessory navicular.<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://carollomb.hatenablog.com/entry/2015/08/14/223041 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.

Última revisión de 07:24 12 jun 2017

Overview
There are three different types of accessory navicular. This extra cartilage, which is turned into bone, is found attached to the posterior tibial tendon, just medial (inside) the navicular bone. The accessory navicular can affect the insertion of the posterior tibial tendon. This tendon has a job of keeping your foot aligned and helping to maintain an arch. The accessory navicular can be associated with a normal foot posture and alignment, or sometime with a flat (pes planus) foot.



Causes
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. Many people with accessory navicular syndrome also have flat feet (fallen arches). Having a flat foot puts more strain on the posterior tibial tendon, which can produce inflammation or irritation of the accessory navicular.

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
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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