Foot Accessory Navicular Excision

Overview
The bones of the foot occasionally develop abnormally in a child and an extra bone called an accessory navicular is present towards the inside of the foot, in front of the ankle. This bone is present in approximately 10% of the general population but not large enough to cause symptoms in the majority of these individuals. The extra bone lump present in childhood can be quite uncomfortable because it rubs on shoes. In addition, the feet associated with the accessory navicular are invariably flat. If the child is active and involved in various athletic activities, this will aggravate the inflammation of the tendon that attaches to the accessory navicular. This tendon is called the posterior tibial tendon and is responsible for maintaining the strength of the arch of the foot. The flat-footedness associated with the accessory navicular usually brings the child for treatment.



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
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
Using PRP treatments, orthotics, proper running 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
The above non-surgical options should be enough to treat accessory navicular syndrome. If they fail, a surgery would be necessary to remove the extra bone that has been causing the problems. The most common procedure for this condition is known as the Kidner procedure where a small incision is made over the navicular bone. The accessory navicular is identified and dissected free from the posterior tibial tendon. The posterior tibial tendon is then reattached to the remaining navicular bone.