Exercises For Accessory Navicular Syndrome

Overview
The accessory navicular (os navicularum or os tibiale externum) is an extra bone or piece of cartilage located on the inner side of the foot just above the arch. It is incorporated within the posterior tibial tendon, which attaches in this area. An accessory navicular is congenital (present at birth). It is not part of normal bone structure and therefore is not present in most people. 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. Many people with accessory navicular syndrome also have flat feet (fallen arches). Having a flat foot puts more strain on the posterior tibial tendon, which can produce inflammation or irritation of the accessory navicular.



Causes
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.

Symptoms
The catalyst for symptoms might be some sort of injury (such as a broken or sprained ankle), excessive activity, or irritation from where shoes are rubbing on the bony prominence the accessory navicular makes. These can irritate the bone, or make the tendon it?s embedded in (the posterior tibial tendon, remember?) inflamed and sore. Because the tendon is compromised in its ability to support the arch, accessory navicular syndrome almost always leads to flat feet, which is one very obvious symptom.

Diagnosis
It is important to examine the posterior tibial tendon and measure the extent of pain to this tendon proximal to the navicular bone. You can clinically determine the amount of posterior tibial tendon involvement by assessing the degree of swelling, pain on palpation and strength. To evaluate the patient?s strength, have the patient stand and balance on one foot along with rising up on his or her toes.

Non Surgical Treatment
Treatment options for a painful accessory navicular can include anti-inflammatory medications, rest, arch support structures in the shoe, or use of a cast or splint. Severe cases may require surgery.



Surgical Treatment
rolotherapy Strengthens the ligaments, tendons and muscle attachments affected by ANS. Prolotherapy is an injection technique that works to strengthen these ligament, tendon, and muscle attachments by causing a mild anti-inflammatory response in the tissues. Prolotherapy supports the body’s normal healing response to injury. The solution directed at the injured and weakened tissue will cause an influx of blood supply and regenerative cells to come to the area. As part of this healing cascade, collagen cells will also be deposited at the injured site. The tissue, which is made mostly of collagen, will become stronger and tighter as these new collagen cells mature. The injured tissue becomes healthy again. When the weakness or injury in these structures is resolved, often times the symptoms with ANS are resolved and the patient no longer suffers from chronic foot pain. In our experience, patients typically feel better soon after treatment. However, if the person desires to run again or continue to be very active, it may take 3-5 treatments to fully resolve the condition. Activity is increased during treatment as symptoms resolve.