Accessory Tarsal Navicular Pain

Overview
An accessory navicular is a fairly uncommon condition which is rarely symptomatic. Oftentimes non-surgical treatment is successful. In the minority of cases, surgical intervention is required. Patients typically do very well with conservative and surgical treatment. Athletic activities can usually be restarted once symptoms have improved or the patient has recovered from surgery.



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
Symptoms of accessory navicular include. Bone lump on the inside of the foot. Redness and swelling. Pain.

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
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.



Surgical Treatment
If non-surgical treatment fails to relieve the symptoms of accessory navicular syndrome, surgery may be appropriate. Surgery may involve removing the accessory bone, reshaping the area, and repairing the posterior tibial tendon to improve its function. This extra bone is not needed for normal foot function.