Everyone has one navicular bone: one of the small bones of the foot. A small number of people have a second small navicular bone or piece of cartilage located on the inside of the foot just above the arch: both are simply called an "accessary navicular bone." It is located within the posterior tibial tendon which attaches in this area. It is easy to see as a "bump." Most that have it never have pain. If they get pain, we call it: "Accessary navicular bone syndrome."
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.
Adolescence is a common time for the symptoms to first appear. This is a time when bones are maturing and cartilage is developing into bone. Sometimes, however, the symptoms do not occur until adulthood. The signs and symptoms of accessory navicular syndrome include a visible bony prominence on the midfoot (the inner side of the foot, just above the arch) Redness and swelling of the bony prominence. Vague pain or throbbing in the midfoot and arch, usually occurring during or after periods of activity.
Usually, you will only need an X-ray to determine the size or type of the accessory navicular bone or the amount of medial navicular tuberosity hypertrophy. Be cognizant of stress fractures which may be duplicated as a hairline fracture or increased calcification. When treating children, always look for avascular necrosis of the navicular (Kohler?s disease). An X-ray of this condition will reveal a flattening of the navicular along with increased bone density.
Non Surgical Treatment
If the foot becomes painful following a twisting type of injury and an X-ray reveals the presence of an accessory navicular bone, your doctor may recommend a period of immobilization in a cast or splint. This will rest the foot and perhaps allow the disruption between the navicular and accessory navicular to heal. Your doctor may prescribe anti-inflammatory medication. Sometimes an arch support can relieve the stress on the fragment and decrease the symptoms. If the pain subsides and the fragment becomes asymptomatic, further treatment may not be necessary.
In my experience, the Modified Kidner procedure is one of the most reliable operations for reducing arch pain associated with an accessory navicular bone (a.k.a. os tibial externum). You can also use this procedure to treat a prominence at the inner aspect of the arch, which has been caused by an enlarged navicular bone. The most common patients to visit our office with these problems are between the ages of 8 and 15 and are involved in activities like How long does Achilles tendonitis last for? ice skating, ballet and soccer.
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