Left Accessory Navicular Excision

Overview
An accessory navicular is defined as an extra bone in the foot, and oftentimes it causes moderate to severe discomfort. Depending on the severity, your doctor may recommend a non-surgical treatment to alleviate the pain, or surgery if treatment doesn?t decrease symptoms.



Causes
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. 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.

Symptoms
A visible bony lump on the inner part of the foot, towards the middle, just above the arch of the foot. Redness, swelling, and sensitivity of the bony prominence. Pain or throbbing in the middle of the foot and the arch. Difficulty with foot movement and activity. Possible skin callous or skin irritation caused by footwear rubbing over the lump. Not everyone who has an accessory navicular will develop these problems. When problems do occur, they may begin in early adolescence. The obvious indication is a painful bump on the inside of the foot, which hurts to touch, and causes problems that gradually become worse, and which are aggravated by activity, walking, etc., leading to all the problems discussed here. Pain may be worse towards the end of the day, and continue into the night.

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
The original procedure advocated by Kidner involved shelling out of the accessory navicular bone from within the insertional area of the posterior tibial tendon and rerouting this tendon under the navicular bone in hopes of restoring a normal pull of this tendon. When treating younger children, history has shown us that simply shelling out of the accessory navicular bone from within the tendon and remodeling the tuberosity of the navicular bone can give you satisfactory results.
In general, you want to reserve advancement of the posterior tibial tendon for adults or those who have a more significant flatfoot deformity. You may also use this approach after determining that quality custom orthotics are only resulting in a slight decrease of symptoms.