Foot Pain Accessory Navicular Bone

Overview
Some people, possibly beginning in early adolescents, but perhaps later, can develop a painful bump on the side of their foot. The pain may be worse after athletic activity or just normal walking, and walking itself may become painful. This pain may become constant, but it will tend to improve with continued rest. Depending on the size of the bump, it may rub against shoes, or cause pain if the bump is hit by something. Over time, the arch of the foot may be lost and a flat food will develop.



Causes
People who have an accessory navicular often are unaware of the condition if it causes no problems. However, some people with this extra bone develop a painful condition known as accessory navicular syndrome when the bone and/or posterior tibial tendon are aggravated. 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.

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
An initial assessment is an orthopaedic office begins with a thorough history and complete physical exam, including an assessment of the posterior tibial tendon and areas of tenderness. Associated misalignments of the ankle and foot should be noted. Finally, weight-bearing x-rays of the foot will help in making the diagnosis. Sometimes, an MRI may be needed to see if the posterior tibial tendon is involved with the symptoms or getting more clarity on the anatomy of the accessory navicular.

Non Surgical Treatment
Using PRP treatments, orthotics, proper local running store 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
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.