Accessory Ossicle Navicular Pain

Overview
The navicular bone of the foot is one of the small bones on the mid-foot. The bone is located at the instep, the arch at the middle of the foot. One of the larger tendons of the foot, called the posterior tibial tendon, attaches to the navicular before continuing under the foot and into the forefoot. This tendon is a tough band of tissue that helps hold up the arch of the foot. If there is an accessory navicular, it is located in the instep where the posterior tibial tendon attaches to the real navicular bone.



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 symptoms of accessory navicular syndrome commonly arise during adolescence, when bones are maturing and cartilage fuses into bone. In other instances, symptoms do not appAccessory Navicularear until adulthood. The signs and symptoms include a visible bony prominence on the midfoot the inner side of the foot above the arch. Redness or swelling of the bony prominence. Indistinct pain or throbbing in the midfoot and arch during or after physical activity.

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
Fortunately, surgery is not the only answer when it comes to relieving symptoms of accessory navicular syndrome. The physician may recommend wearing a cast or walking boot for a period of time so the foot can recover from the inflammation. Ice may be used to relieve swelling, too, although it should be wrapped to avoid direct contact with the skin.



Surgical Treatment
In the original Kidner procedure, the entire posterior tibial tendon was released from the navicular and then rerouted through a drill hole placed through the navicular. The original Kidner procedure is now rarely used as a means of treating an isolated accessory navicular. Instead, a modification of the Kidner procedure has become more commonplace. The modified Kidner procedure consists of carefully removing the accessory and anchoring the posterior tibial tendon to the surface of the navicular where the accessory was removed. The repair may be done by passing a suture through the tendon and then through drill holes in the navicular, or by using a suture anchor.