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Overview<br>When there The navicular bone is injury to located on the muscle, fibrous tissue, or soft tissue top of the navicular and foot near the accessory navicular bones, symptoms will arisearch. This injury allows excessive movement between the bones. Fibrous tissue, ligaments and tendons People who have poor blood supply and are prone to poor healing. Often, this extra navicular bone lies near can feel a bump or attaches to bony protuberance on the posterior tibial tendon. (See figure.) When top of the posterior tibial muscle contracts with movements such as foot inversion or plantar flexion, above the posterior tendon moves and arch. While the bone itself does not cause pain, accessory navicular syndrome can develop when the bone movesand/or nearby tendon is irritated. This can cause severe pain in those with Accessory Navicular Syndrome. It can become disabling The navicular bone is attached to patients because muscles, ligaments and the posterior tibial tendon attached . Since ligaments and tendons have poor blood supply and don?t heal easily, any irritation to the navicular bone is responsible for supporting the medial arch during standing, walking and runningsurrounding structures can develop into a painful condition. Activities which most of us do daily!<br><br><br><br>Causes<br>Accessory navicular syndrome as it is called can result from a number Most of causesthe time, excess or overuse syndrome as seen in an athletethis condition is asymptomatic and people may live their whole lives unaware that they even have this extra bone. Trauma to the foot as in an ankle sprain or direct trauma to The main reason the accessory navicular bonebecomes problematic is when pain occurs. chronic irritation from shoes rubbing against the extra bone, over time, may cause There is no need for intervention if there is no pain. Excessive pronation which strains the attachment of tibialis posterior muscles into the The accessory navicular bone. Keep is easily felt in mind, the larger medial arch because it forms a bony prominence there. Pain may occur if the actual accessory bone, is overly large causing this bump on the greater the chance of it becoming an issueinstep to rub against footwear.<br><br>Symptoms<br>This painful condition is called Many people have accessory (?extra?) naviculars (figure 1) - a prominent extra bone extending from the navicular syndromebone. Most accessory naviculars are completely asymptomatic. Accessory navicular syndrome (ANS) can cause significant However, some individuals will develop pain in on the mid-foot and arch, especially with activityinside of their midfoot. Redness and swelling Pain may develop over this bony occur from the pressure of the shoe ware against the prominence, irritating either the bone itself or the fibrous junction where the accessory bone meets the regular navicular. Alternatively, the fibrous junction or interface may become painful as well as extreme sensitivity to pressurea result of tension applied by the posterior tibial tendon through its connection or insertion at that site. Sometimes people may Often, individuals will be unable to wear asymptomatic for years, however, a new pair of shoes because or a change in their activity level can cause symptoms. The accessory navicular itself typically develops during adolescence, when the two areas of the area is too sensitivenavicular bone fail to fuse together.<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://Oziehismanevasiveanyplace79.blog.Fc2exteen.com/blog-entry-15.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 Excess weight will increase the force on the posterior tibial tendon as it inserts into the accessory navicular syndrome is and will tend to relieve the precipitate or aggravate symptoms. The following may be used. Placing the foot in If a cast or removable walking boot allows the affected area to rest and decreases the inflammation. To reduce swelling, a bag of ice covered patient with a thin towel symptomatic accessory navicular is applied to the affected area. Do not put ice directly on the skin. Nonsteroidal anti-inflammatory drugs (NSAIDs)overweight, such as ibuprofen, may then losing weight can be prescribedvery helpful. 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 Even losing 5-10lbs will decrease the muscles and decrease inflammation. The exercises may also help prevent recurrence amount of force going through the symptomsfoot with each step by as much as 15-30lbs. Custom orthotic devices that fit into This is because the shoe provide support for foot acts like a lever serving to magnify the arch, and may play a role in preventing future symptoms. Even after successful treatment, force absorbed by the symptoms of accessory navicular syndrome sometimes reappear. When this happens, non-surgical approaches are usually repeatedfoot with each step.<br><br><br><br>Surgical Treatment<br>Surgery may Depending upon the severity the non operative or conservative treatment should be an option if nonmaintained for at least 4-6 months before any surgical treatment does not decrease 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 syndrome. Since this bone Bone is not needed for removed to the point where the medial foot to function normally, Your surgeon may remove has no bony prominence over the accessory navicular, reshape between the head of the area, talus and first cuneiform. Symptoms are relieved in 90% of cases. Second is Kindler procedure. In this the ossicle and repair navicular prominence is excised as in simple excision but along with the posterior tibial tendon for improved functionadvancement. 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.