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Overview<br>There are three different types of The accessory navicular. This (os navicularum or os tibiale externum) is an extra bone or piece of cartilage, which located on the inner side of the foot just above the arch. It is turned into bone, is found attached to incorporated within the posterior tibial tendon, just medial (inside) the navicular bonewhich attaches in this area. The An accessory navicular can affect the insertion of the posterior tibial tendonis congenital (present at birth). This tendon has a job It is not part of keeping your foot aligned and helping to maintain an arch. The accessory navicular can be associated with a normal foot posture bone structure and alignment, or sometime with a flat (pes planus) foottherefore is not present in most people.<br><br><br><br>Causes<br>This Accessory navicular syndrome as it is called can result from any a number of the followingcauses, excess or overuse syndrome as seen in an athlete. Trauma, to the foot as in a foot or an ankle sprainor direct trauma to the navicular bone. Chronic chronic irritation from shoes or other footwear rubbing against the extra bone, over time, may cause pain. Excessive activity or overuse. Many people with accessory pronation which strains the attachment of tibialis posterior muscles into the navicular syndrome also have flat feet (fallen arches)bone. Having a flat foot puts more strain on Keep in mind, the larger the posterior tibial tendonactual accessory bone, which can produce inflammation or irritation the greater the chance of the accessory navicularit becoming an issue.<br><br>Symptoms<br>The primary reason an This painful condition is called accessory navicular becomes a problem is painsyndrome. There is no need to do anything with an accessory Accessory navicular that is not causing syndrome (ANS) can cause significant painin the mid-foot and arch, especially with activity. The pain is usually at the instep area Redness and can be pinpointed swelling may develop over the small bump in the instepthis bony prominence, as well as extreme sensitivity to pressure. Walking can Sometimes people may be painful when unable to wear shoes because the problem is aggravated. As stated earlier, the condition area is more common in girls. The problem commonly becomes symptomatic in the teenage yearstoo sensitive.<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://angelinemlenarannamariefron.hatenablogblogas.com lt/?p=9&akst_action=share-this heel spurs] and plantar fasciitis, it?s important to seek treatment.<br><br>Non Surgical Treatment<br>Most children?s symptoms are improved Patients with a painful accessory navicular may benefit with four to six physical therapy treatments. Your therapist may design a series of stretching exercises to try and ease tension on the posterior tibial tendon. A shoe insert, or resolved by taking a break from orthotic, may be used to support the arch and protect the sore area. This approach may allow you to resume normal walking immediately, but you should probably cut back on more vigorous activities that irritate their feetfor several weeks to allow the inflammation and pain to subside. Shoe inserts that pad Treatments directed to the accessory navicular painful area are also helpfulhelp control pain and swelling. Examples include ultrasound, moist heat, and soft-tissue massage. If your child?s symptoms do not improveTherapy sessions sometimes include iontophoresis, your physician may recommend which uses a belowmild electrical current to push anti-inflammatory medicine to the-knee cast or walking boot. Surgery is rarely neededsore area.<br><br><br><br>Surgical Treatment<br>If Depending upon the severity the nonoperative or conservative treatment should be maintained for at least 4-6 months before any surgical treatment fails 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 relieve the symptoms prominence of accessory navicular syndrome, surgery may be appropriate. Surgery may involve removing Bone is removed to the point where the medial foot has no bony prominence over the accessory bonenavicular, reshaping between the head of the talus and first cuneiform. Symptoms are relieved in 90% of cases. Second is Kindler procedure. In this the area, ossicle and repairing 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 improve its functionprovide 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. This extra bone When the cast is not needed for normal foot functionbeing removed can start building up the ROM to counter atrophy and other physical therapy treatment which include stretching and strengthening exercises.