Pain After Accessory Navicular Surgery

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
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
Symptoms of this syndrome would include redness, swelling and tenderness over the navicular bone. The navicular bone is located on the inside of the foot approximately midway between the ankle bone and big toe joint. It will tend to be worse after activity and can be aggravated by those that wear very dressy shoes as opposed to casual shoes like sneakers. In other words, the flatter or less supportive the shoe, the greater the chance for 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
A combination of the following non-surgical treatments may be used to relieve the symptoms of accessory navicular syndrome. Immobilizing the foot with a cast or a removable walking boot allows the foot to rest and reduces inflammation. Applying ice to the affected area is an effective way to reduce swelling and inflammation. Wrap a bag of ice with a thin towel and apply for intervals of 15 to 20 minutes. Never put ice directly on the skin. Oral nonsteroidal anti-inflammatory drugs (NSAIDs) including aspirin or ibuprofen might be prescribed. Sometimes, a combination of immobilization and oral or injected corticosteroid medications may reduce pain and inflammation. Physical therapy may be prescribed to include exercises and treatments that increase muscle strength, decrease inflammation and help prevent the recurrence of symptoms. Custom orthotic devices worn in the shoe provide arch support and may prevent future symptoms from developing. The symptoms of this syndrome may reappear even after successful treatment. If so, non-surgical treatments are often repeated.



Surgical Treatment
The original procedure advocated by Kidner involved shelling out of the accessory navicular bone from within the insertional area of the posterior tibial tendon and rerouting this tendon under the navicular bone in hopes of restoring a normal pull of this tendon. When treating younger children, history has shown us that simply shelling out of the accessory navicular bone from within the tendon and remodeling the tuberosity of the navicular bone can give you satisfactory results.
In general, you want to reserve advancement of the posterior tibial tendon for adults or those who have a more significant flatfoot deformity. You may also use this approach after determining that quality custom orthotics are only resulting in a slight decrease of symptoms.