Does Accessory Navicular Syndrome Require Surgery

Overview
The accessory navicular is an extra piece of cartilage or bone on the inner side of the foot. It is found in about 10 percent of individuals and is present at birth. Many people who have an accessory navicular are never aware of it because they do not experience symptoms. However, aggravation of the accessory navicular or the posterior tibia tendon, which it is attached to, can develop as a result of trauma, irritation from shoes, and excessive overuse.



Causes
Like all painful conditions, ANS has a root cause. The cause could be the accessory navicular bone itself producing irritation from shoes or too much activity. Often, however, it is related to injury of one of the structures that attach to the navicular bone. Structures that attach to the navicular bone include abductor hallucis muscle, plantar calcaneonavicular ligament (spring ligament) parts of the deltoid ligament, posterior tibial tendon.

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
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
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.