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Overview<br>The accessory navicular is an ossicle, or extra bone located medially to the navicular. Depending on the type, or stage, it may be connected to the navicular by a fibrous union, via a type of joint called a synchrondrosis. In those who have this extra bone, it is present at birth, but it starts as soft cartilage and then begins to ossify (turn into bone) at around age nine. Some sources believe that, in about half of those who have it, the bone will fuse to the navicular in late adolescence, but it is not clear that this actually happens.<br><br><br><br>Causes<br>It is commonly believed that the posterior tibial tendon loses its vector of pull to heighten the arch. As the posterior muscle contracts, the tendon is no longer pulling straight up on the navicular but must course around the prominence of bone and first pull medially before pulling upward. In addition, the enlarged bones may irritate and damage the insertional area of the posterior tibial tendon, making it less functional. Therefore, the presence of the accessory navicular bone does contribute to posterior tibial dysfunction.<br><br>Symptoms<br>Symptoms of this syndrome would include redness, swelling and tenderness over the navicular bone. The navicular bone is located on the inside of the foot approximately midway between the ankle bone and big toe joint. It will tend to be worse after activity and can be aggravated by those that wear very dressy shoes as opposed to casual shoes like sneakers. In other words, the flatter or less supportive the shoe, the greater the chance for pain.<br><br>Diagnosis<br>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, [http://Isadorakraemer.blog.fc2.com/blog-entry-34.html heel spurs] and plantar fasciitis, it?s important to seek treatment.<br><br>Non Surgical Treatment<br>The goal of non-surgical treatment for accessory navicular syndrome is to relieve the symptoms. The following may be used. Immobilization. Placing the foot in a cast or removable walking boot allows the affected area to rest and decreases the inflammation. Ice. To reduce swelling, a bag of ice covered with a thin towel is applied to the affected area. Do not put ice directly on the skin. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be prescribed. In some cases, oral or injected steroid medications may be used in combination with immobilization to reduce pain and inflammation. Physical therapy may be prescribed, including exercises and treatments to strengthen the muscles and decrease inflammation. The exercises may also help prevent recurrence of the symptoms. Custom orthotic devices that fit into the shoe provide support for the arch, and may play a role in preventing future symptoms. Even after successful treatment, the symptoms of accessory navicular syndrome sometimes reappear. When this happens, non-surgical approaches are usually repeated.<br><br><br><br>Surgical Treatment<br>If all nonsurgical measures fail and the fragment continues to be painful, surgery may be recommended. The most common procedure used to treat the symptomatic accessory navicular is the Kidner procedure. A small incision is made in the instep of the foot over the accessory navicular. The accessory navicular is then detached from the posterior tibial tendon and removed from the foot. The posterior tibial tendon is reattached to the remaining normal navicular. Following the procedure, the skin incision is closed with stitches, and a bulky bandage and splint are applied to the foot and ankle. You may need to use crutches for several days after surgery. Your stitches will be removed in 10 to 14 days (unless they are the absorbable type, which will not need to be taken out). You should be safe to be released to full activity in about six weeks.
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Overview<br>An accessory navicular bone is an accessory bone of the foot that occasionally develops abnormally in front of the ankle towards the inside of the foot. This bone may be present in approximately 2-14% of the general population and is usually asymptomatic. When it is symptomatic, surgery may be necessary. Surgery can be performed at any age because it does not alter any other bones.<br><br><br><br>Causes<br>Most of the time, this condition is asymptomatic and people may live their whole lives unaware that they even have this extra bone. The main reason the accessory navicular bone becomes problematic is when pain occurs. There is no need for intervention if there is no pain. The accessory navicular bone is easily felt in the medial arch because it forms a bony prominence there. Pain may occur if the accessory bone is overly large causing this bump on the instep to rub against footwear.<br><br>Symptoms<br>This painful condition is called accessory navicular syndrome. Accessory navicular syndrome (ANS) can cause significant pain in the mid-foot and arch, especially with activity. Redness and swelling may develop over this bony prominence, as well as extreme sensitivity to pressure. Sometimes people may be unable to wear shoes because the area is too sensitive.<br><br>Diagnosis<br>Plain x-rays are used to determine the size of the accessory navicular. There are three main types of accessory navicular bones: a small bone embedded within the nearby posterior tibial tendon; a triangular shaped bone connected to the navicular by thick cartilage; and a large prominent navicular tuberosity thought to represent an accessory navicular that has fused to the navicular. If the status of the posterior tibial tendon needs to be assessed or if other problems are suspected, (ex. Navicular stress fracture) it may be necessary to perform an MRI. Although this is not considered routine, an MRI may be helpful in identifying the degree of irritation. An MRI would demonstrate fluid or edema that may accumulate in the bone as a result of the irritation.<br><br>Non Surgical Treatment<br>Aside from surgery, there are a few options for handling an accessory navicular bone that has become symptomatic. This includes immobilization, icing, medicating, physical therapy, and orthotic devices. Immobilizing involves placing the foot and ankle in a cast or removable walking boot. This alleviates stressors on the foot and can decrease inflammation. Icing will help reduce swelling and inflammation. Medication involves usage of nonsteroidal anti-inflammatory drugs, or steroids (taken orally or injected) to decrease inflammation. Physical therapy can be prescribed in order to strengthen the muscles and help decrease inflammation. Physical therapy can also help prevent the symptoms from returning. Orthotic devices (arch support devices that fit in a shoe) can help prevent future symptoms. Occasionally, the orthotic device will dig into the edge of the accessory navicular and cause discomfort. For this reason, the orthotic devices made for the patient should be carefully constructed.<br><br><br><br>Surgical Treatment<br>Depending upon the severity the non operative or conservative treatment should be maintained for at least 4- 6 months before any surgical intervention. There are 2 surgeries that can be performed depending upon the condition and symptoms. First is simple surgical excision. In this generally the accessory navicular along with its prominence is removed. In this procedure, skin incision is made dorsally to the prominence of accessory navicular. Bone is removed to the point [http://catinaturomsha.jigsy.com/entries/general/heel-discomfort-the-causes-warning-signs-and-therapy-choices Where is the Achilles heel?] the medial foot has no bony prominence over the navicular, between the head of the talus and first cuneiform. Symptoms are relieved in 90% of cases. Second is Kindler procedure. In this the ossicle and navicular prominence is excised as in simple excision but along with the posterior tibial tendon advancement. Posterior tibial tendon is split and advanced along the medial side of foot to provide support to longitudinal arch. After surgery 4 week short leg cast, well moulded into the arch with the foot plantigrade is applied. Partial weight bearing till the 8th week and later full weight bearing is allowed. When the cast is being removed can start building up the ROM to counter atrophy and other physical therapy treatment which include stretching and strengthening exercises.<br><br>Th1s1sanart1cl3s1te

Aktuelle Version vom 10. August 2017, 08:33 Uhr

Overview
An accessory navicular bone is an accessory bone of the foot that occasionally develops abnormally in front of the ankle towards the inside of the foot. This bone may be present in approximately 2-14% of the general population and is usually asymptomatic. When it is symptomatic, surgery may be necessary. Surgery can be performed at any age because it does not alter any other bones.



Causes
Most of the time, this condition is asymptomatic and people may live their whole lives unaware that they even have this extra bone. The main reason the accessory navicular bone becomes problematic is when pain occurs. There is no need for intervention if there is no pain. The accessory navicular bone is easily felt in the medial arch because it forms a bony prominence there. Pain may occur if the accessory bone is overly large causing this bump on the instep to rub against footwear.

Symptoms
This painful condition is called accessory navicular syndrome. Accessory navicular syndrome (ANS) can cause significant pain in the mid-foot and arch, especially with activity. Redness and swelling may develop over this bony prominence, as well as extreme sensitivity to pressure. Sometimes people may be unable to wear shoes because the area is too sensitive.

Diagnosis
Plain x-rays are used to determine the size of the accessory navicular. There are three main types of accessory navicular bones: a small bone embedded within the nearby posterior tibial tendon; a triangular shaped bone connected to the navicular by thick cartilage; and a large prominent navicular tuberosity thought to represent an accessory navicular that has fused to the navicular. If the status of the posterior tibial tendon needs to be assessed or if other problems are suspected, (ex. Navicular stress fracture) it may be necessary to perform an MRI. Although this is not considered routine, an MRI may be helpful in identifying the degree of irritation. An MRI would demonstrate fluid or edema that may accumulate in the bone as a result of the irritation.

Non Surgical Treatment
Aside from surgery, there are a few options for handling an accessory navicular bone that has become symptomatic. This includes immobilization, icing, medicating, physical therapy, and orthotic devices. Immobilizing involves placing the foot and ankle in a cast or removable walking boot. This alleviates stressors on the foot and can decrease inflammation. Icing will help reduce swelling and inflammation. Medication involves usage of nonsteroidal anti-inflammatory drugs, or steroids (taken orally or injected) to decrease inflammation. Physical therapy can be prescribed in order to strengthen the muscles and help decrease inflammation. Physical therapy can also help prevent the symptoms from returning. Orthotic devices (arch support devices that fit in a shoe) can help prevent future symptoms. Occasionally, the orthotic device will dig into the edge of the accessory navicular and cause discomfort. For this reason, the orthotic devices made for the patient should be carefully constructed.



Surgical Treatment
Depending upon the severity the non operative or conservative treatment should be maintained for at least 4- 6 months before any surgical intervention. There are 2 surgeries that can be performed depending upon the condition and symptoms. First is simple surgical excision. In this generally the accessory navicular along with its prominence is removed. In this procedure, skin incision is made dorsally to the prominence of accessory navicular. Bone is removed to the point Where is the Achilles heel? the medial foot has no bony prominence over the navicular, between the head of the talus and first cuneiform. Symptoms are relieved in 90% of cases. Second is Kindler procedure. In this the ossicle and navicular prominence is excised as in simple excision but along with the posterior tibial tendon advancement. Posterior tibial tendon is split and advanced along the medial side of foot to provide support to longitudinal arch. After surgery 4 week short leg cast, well moulded into the arch with the foot plantigrade is applied. Partial weight bearing till the 8th week and later full weight bearing is allowed. When the cast is being removed can start building up the ROM to counter atrophy and other physical therapy treatment which include stretching and strengthening exercises.

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