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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 also termed the os navicularum or os tibiale externum - is an extra bone or piece of cartilage on the inner side of the foot above the arch that attaches to the posterior tibial tendon within this area. This extra bone, present at birth, is not part of the normal bone structure and found in approximately 10% of the population. Some people with an accessory navicular may be unaware of the condition if symptoms are never experienced. But accessory navicular syndrome is a painful condition caused  by aggravating the bone, the posterior tibial tendon or both.\Accessory navicular syndrome is an irritation of the accessory navicular and/or posterior tibial tendon. This irritation can be caused by shoe rubbing, trauma, excessive activity, or overuse and can cause problems with the shape and function of your foot. Many people with this disorder also have flat feet which puts more strain on the posterior tibial tendon. Some people are born with an accessory Navicular because during development, the bones of the feet sometimes develop abnormally causing the extra bone to form on the inside of the foot.<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>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>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://cindapriess.hatenablog.com/entries/2015/08/15 heel spurs] and plantar fasciitis, it?s important to seek treatment.<br><br>Non Surgical Treatment<br>Most cases of accessory navicular syndrome may be treated conservatively with some sort of immobilization. This should allow the fibrous tissue between the two bones to heal. If a patient is extremely flat footed (pronated) then I lean more towards an orthotic than a boot as my main goal is to keep the patient's foot from flattening out too much and thus reduce the strain on the two bones. Supplementation with ice, oral anti-inflammatory medication. If the patient is athletic sometimes we can keep them active with an orthotic, but other times they have to give up their sport for a period of time to allow the condition to heal.<br><br><br><br>Surgical Treatment<br>If conservative measures do not seem to help, however, you may need to have surgery to make adjustments to the bump. This could include reshaping the little bone, repairing damage to the posterior tibial tendon, or even removing the accessory navicular altogether.

Revisión de 14:31 11 jun 2017

Overview
The accessory navicular also termed the os navicularum or os tibiale externum - is an extra bone or piece of cartilage on the inner side of the foot above the arch that attaches to the posterior tibial tendon within this area. This extra bone, present at birth, is not part of the normal bone structure and found in approximately 10% of the population. Some people with an accessory navicular may be unaware of the condition if symptoms are never experienced. But accessory navicular syndrome is a painful condition caused by aggravating the bone, the posterior tibial tendon or both.\Accessory navicular syndrome is an irritation of the accessory navicular and/or posterior tibial tendon. This irritation can be caused by shoe rubbing, trauma, excessive activity, or overuse and can cause problems with the shape and function of your foot. Many people with this disorder also have flat feet which puts more strain on the posterior tibial tendon. Some people are born with an accessory Navicular because during development, the bones of the feet sometimes develop abnormally causing the extra bone to form on the inside of the foot.



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
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).

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
Most cases of accessory navicular syndrome may be treated conservatively with some sort of immobilization. This should allow the fibrous tissue between the two bones to heal. If a patient is extremely flat footed (pronated) then I lean more towards an orthotic than a boot as my main goal is to keep the patient's foot from flattening out too much and thus reduce the strain on the two bones. Supplementation with ice, oral anti-inflammatory medication. If the patient is athletic sometimes we can keep them active with an orthotic, but other times they have to give up their sport for a period of time to allow the condition to heal.



Surgical Treatment
If conservative measures do not seem to help, however, you may need to have surgery to make adjustments to the bump. This could include reshaping the little bone, repairing damage to the posterior tibial tendon, or even removing the accessory navicular altogether.