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Overview<br>The accessory navicular is a congenital anomaly, meaning that you are born with the extra bone. As the skeleton completely matures, the navicular and the accessory navicular never completely grow, or fuse, into one solid bone. The two bones are joined by fibrous tissue or cartilage. Girls seem to be more likely to have an accessory navicular than boys.<br><br><br><br>Causes<br>This painful foot condition is caused by an extra bone in the foot called the accessory navicular. Only about 10% of people have this bone (4 to 21%), and not all of them will develop any symptoms. The navicular bone is one of the normal tarsal bones of the foot. It is located on the inside of the foot, at the arch.<br><br>Symptoms<br>The primary reason an accessory navicular becomes a problem is pain. There is no need to do anything with an accessory navicular that is not causing pain. The pain is usually at the instep area and can be pinpointed over the small bump in the instep. Walking can be painful when the problem is aggravated. As stated earlier, the condition is more common in girls. The problem commonly becomes symptomatic in the teenage years.<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://sylvialeichtenberge.blogas.lt/tema/be-temos heel spurs] and plantar fasciitis, it?s important to seek treatment.<br><br>Non Surgical Treatment<br>Many individuals with symptomatic accessory naviculars can be managed successfully without surgery. Standard non-surgical treatment includes shoes that are soft around the inside of the ankle can allow for any excess prominence of bone. Therefore, it is recommended that either shoes with plenty of padding and space in the ankle area are purchased, or pre-owned shoes can be modified by a shoemaker to create extra space in this area. For example, many patients will get their ski boots expanded in the area around the prominence, minimizing irritation. In addition, a shoe with a stiff sole will help disperse force away from the arch of the foot during walking, thereby minimizing the force on the posterior tibial tendon. An off-the-shelf arch support may help decrease the stress applied by the posterior tibial tendon.  If necessary, an ankle brace applied to provide more substantial support to the arch may be successful where a simple arch support fails.<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>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>It is commonly believed that the posterior tibial tendon loses its vector of pull to heighten the arch. As the posterior muscle contracts, the tendon is no longer pulling straight up on the navicular but must course around the prominence of bone and first pull medially before pulling upward. In addition, the enlarged bones may irritate and damage the insertional area of the posterior tibial tendon, making it less functional. Therefore, the presence of the accessory navicular bone does contribute to posterior tibial dysfunction.<br><br>Symptoms<br>Symptoms of accessory navicular syndrome often appear in adolescence, when bones are maturing. Symptoms include A visible bony prominence on the midfoot, Redness and swelling, Vague pain or throbbing in the arch, especially after 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://thinkablemedal63.snack.ws/hammer-toes-pain-in-ball-of-foot.html heel spurs] and plantar fasciitis, it?s important to seek treatment.<br><br>Non Surgical Treatment<br>Using PRP treatments, orthotics, proper running 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>Fusion of the accessory navicular to the navicular with screws is required when there is a large accessory navicular bone and removal of this bone would reduce the articular surface of the Navicular to the talus (coxa pedis). Fusion will relieve pain without disrupting the tibialis posterior tendon insertion nor narrowing talar head support. In most instances, a patient’s recovery will be as follows. 0-6 weeks: Immobilization (in case or cast boot) non-weight-bearing or touch weight-bearing. 6-10 weeks: Increasing activity in a cast boot. Physical therapy to work on strength and balance. Full recovery after 9 weeks-2 months. In some patients (where the posterior tibial tendon is still intact and functioning) the treating surgeon may allow weight-bearing as tolerated in a cast boot immediately after surgery.

Revisión de 00:25 12 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
It is commonly believed that the posterior tibial tendon loses its vector of pull to heighten the arch. As the posterior muscle contracts, the tendon is no longer pulling straight up on the navicular but must course around the prominence of bone and first pull medially before pulling upward. In addition, the enlarged bones may irritate and damage the insertional area of the posterior tibial tendon, making it less functional. Therefore, the presence of the accessory navicular bone does contribute to posterior tibial dysfunction.

Symptoms
Symptoms of accessory navicular syndrome often appear in adolescence, when bones are maturing. Symptoms include A visible bony prominence on the midfoot, Redness and swelling, Vague pain or throbbing in the arch, especially after 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
Using PRP treatments, orthotics, proper running 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).



Surgical Treatment
Fusion of the accessory navicular to the navicular with screws is required when there is a large accessory navicular bone and removal of this bone would reduce the articular surface of the Navicular to the talus (coxa pedis). Fusion will relieve pain without disrupting the tibialis posterior tendon insertion nor narrowing talar head support. In most instances, a patient’s recovery will be as follows. 0-6 weeks: Immobilization (in case or cast boot) non-weight-bearing or touch weight-bearing. 6-10 weeks: Increasing activity in a cast boot. Physical therapy to work on strength and balance. Full recovery after 9 weeks-2 months. In some patients (where the posterior tibial tendon is still intact and functioning) the treating surgeon may allow weight-bearing as tolerated in a cast boot immediately after surgery.

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