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Overview<br>The accessory navicular (os navicularum or os tibiale externum) is an extra bone or piece of cartilage or bone located on the inner side of the footjust above the arch. It is found incorporated within the posterior tibial tendon, which attaches in about 10 percent of individuals and this area. An accessory navicular is congenital (present at birth). Many people who have an accessory navicular are never aware of it because they do It is not experience symptoms. However, aggravation part of the accessory navicular or the posterior tibia tendon, which it normal bone structure and therefore is attached to, can develop as a result of trauma, irritation from shoes, and excessive overusenot present in most people.<br><br><br><br>Causes<br>Accessory navicular syndrome as it is called can result from a number of causes, excess or overuse syndrome as seen in an athlete. Trauma to the foot as in an ankle sprain or direct trauma to the navicular bone. chronic irritation from shoes rubbing against the extra bone, over time, may cause pain. Excessive pronation which strains the attachment of tibialis posterior muscles into the navicular bone. Keep in mind, the larger the actual accessory bone, the greater the chance of it becoming an issue.<br><br>Symptoms<br>The majority of people with an This painful condition is called accessory navicular experience no symptoms, since, for syndrome. Accessory navicular syndrome (ANS) can cause significant pain in the most partmid-foot and arch, the little extra bone simply isn?t large enough to cause problemsespecially with activity. UnfortunatelyRedness and swelling may develop over this bony prominence, some people lose on ?accessory navicular roulette,? and the bone begins as well as extreme sensitivity to mess things up with the footpressure. These problems usually show up sometime in adolescence, when bones and cartilage in the body are settling into their final shapes (although occasionally Sometimes people make it all may be unable to wear shoes because the way through childhood, only to start experiencing discomfort and pain in adulthood)area is too 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://ickyprogression13annamariefron.Hazblogblogas.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>The treatment for Patients with a symptomatic painful accessory navicular can 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 orthotic, may be divided into nonsurgical treatment 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 for several weeks to allow the inflammation and surgical treatmentpain to subside. In Treatments directed to the vast majority of casespainful area help control pain and swelling. Examples include ultrasound, treatment usually begins with nonsurgical measures such as orthoticsmoist heat, strappings or bracingand soft-tissue massage. Surgery usually is only considered when all nonsurgical measures have failed Therapy sessions sometimes include iontophoresis, which uses a mild electrical current to push anti-inflammatory medicine to control your problem and the pain becomes intolerablesore area.<br><br><br><br>Surgical Treatment<br>If Depending upon the severity the non operative or conservative care does not alleviate the problem then treatment should be maintained for at least 4- 6 months before any surgical intervention should . There are 2 surgeries that can be consideredperformed depending upon the condition and symptoms. First is simple surgical excision. The most common procedure for In this condition generally the accessory navicular along with its prominence is known as the Kidner removed. In this procedure where a small , skin incision is made dorsally to the prominence of accessory navicular. Bone is removed to the point where the medial foot has no bony prominence over the navicular bone, between the head of the talus and first cuneiform. Symptoms are relieved in 90% of cases. Second is Kindler procedure. The accessory In this the ossicle and navicular prominence is identified and dissected free from excised as in simple excision but along with the posterior tibial tendonadvancement. The posterior Posterior tibial tendon is then reattached 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 remaining navicular bone8th 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.