Exercises To Help Accessory Navicular Syndrome

Overview
Sometimes, feet do weird things. For instance, about 10% of the general population?s feet have decided that having an extra bone in the mix is a really great idea. This extra bone (or sometimes a bit of cartilage), is called an accessory navicular. It shows up in a tendon called the posterior tibial tendon (which is a fancy name - but just remember, it helps support the arch of the foot) on the middle of the inside of the foot, just above the arch. This extra little bone is present from birth, so it?s not something that?ll suddenly grow later in life. Now, accessory navicular syndrome is when that extra bone starts causing issues with your shoe-wearing, or even the shape and function of your foot. It?s the syndrome you want to worry about, not necessarily the extra bone itself.



Causes
An accessory navicular develops as a result of a congenital anomaly and is found more often in women. If the bone is large, it may rub against a shoe, causing pain. Because of its location, the posterior tibial tendon may pull on the bone during walking or running, causing the fibrous tissue that connects the accessory navicular to the navicular to tear and become inflamed.

Symptoms
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.

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
The initial treatment approach for accessory navicular is non-operative. An orthotic may be recommended or the patient may undergo a brief period of casting to rest the foot. For chronic pain, however, the orthopedic surgeon removes the extra bone, a relatively simple surgery with a brief rehabilitation period and a very good success rate.



Surgical Treatment
For patients who have failed conservative care or who have had recurrent symptoms, surgery can be considered. Surgical intervention requires an excision of the accessory navicular and reattachment of the posterior tibial tendon to the navicular. Often times, this is the only procedure necessary. However, if there are other deformities such as a flat foot or forefoot that is abducted, other procedures may be required.