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Overview<br>In The accessory navicular (os navicularum or os tibiale externum) is an ideal situation, extra bone or piece of cartilage located on the inner side of the navicular bone and foot just above the accessory bone will fuse together to form one bonearch. The problem that occurs It is that sometimes incorporated within the two bones do not fuse together and the patient posterior tibial tendon, which attaches in this area. An accessory navicular is left with what congenital (present at birth). It is known as a fibrous union or basically a non solid union not part of normal bone to bone. This fibrous union structure and therefore is more like scar tissue and not present in theory can cause pain when excessive strain is placed upon itmost people.<br><br><br><br>Causes<br>Just having an accessory Accessory navicular bone syndrome as it is not necessarily called can result from a bad thingnumber of causes, excess or overuse syndrome as seen in an athlete. Not all people with these accessory bones have symptoms. Symptoms arise when Trauma to the foot as in an ankle sprain or direct trauma to the accessory navicular is overly large or when an injury disrupts bone. chronic irritation from shoes rubbing against the fibrous tissue between extra bone, over time, may cause pain. Excessive pronation which strains the navicular and attachment of tibialis posterior muscles into the accessory navicularbone. A very large Keep in mind, the larger the actual accessory navicular can cause a bump on bone, the greater the instep that rubs on your shoe causing painchance of it becoming an issue.<br><br>Symptoms<br>Most people with an This painful condition is called accessory navicular do not have symptoms because syndrome. Accessory navicular syndrome (ANS) can cause significant pain in the bone is so small that it causes no harmmid-foot and arch, or only especially with activity. Redness and swelling may develop symptoms after a trauma such over this bony prominence, as well as a break or sprainextreme sensitivity to pressure. When symptoms are present they could Sometimes people may be a visible bony prominence, pain and throbbing, inflammation and redness, and flat feetunable to wear shoes because the 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://nostalgicdepict29annamariefron.sosblogsblogas.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 goal of non-surgical treatment for Patients with a painful accessory navicular syndrome is may benefit with four to relieve the symptomssix physical therapy treatments. The following Your therapist may be used. Placing the foot in design a cast or removable walking boot allows the affected area series of stretching exercises to rest try and decreases the inflammation. To reduce swelling, a bag of ice covered with a thin towel is applied to the affected area. Do not put ice directly ease tension on the skinposterior tibial tendon. Nonsteroidal anti-inflammatory drugs (NSAIDs)A shoe insert, such as ibuprofen, may be prescribed. In some casesor orthotic, oral or injected steroid medications may be used in combination with immobilization to reduce pain support the arch and inflammationprotect the sore area. Physical therapy This approach may be prescribedallow you to resume normal walking immediately, including exercises and treatments but you should probably cut back on more vigorous activities for several weeks to strengthen allow the muscles inflammation and decrease inflammationpain to subside. The exercises may also Treatments directed to the painful area help prevent recurrence of the symptomscontrol pain and swelling. Custom orthotic devices that fit into the shoe provide support for the archExamples include ultrasound, moist heat, and may play a role in preventing future symptomssoft-tissue massage. Even after successful treatment, the symptoms of accessory navicular syndrome Therapy sessions sometimes reappear. When this happensinclude iontophoresis, nonwhich uses a mild electrical current to push anti-surgical approaches are usually repeatedinflammatory medicine to the sore area.<br><br><br><br>Surgical Treatment<br>If Depending upon the severity the non-operative or conservative treatment fails to relieve should be maintained for at least 4- 6 months before any surgical intervention. There are 2 surgeries that can be performed depending upon the patient’s condition and symptoms, . First is simple surgical intervention may be warrantedexcision. In this generally the accessory navicular along with its prominence is removed. The standard operative treatment In this procedure, skin incision is made dorsally to the prominence of an accessory navicular . Bone is removed to the point where 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 a Kidner Kindler procedure. HoweverIn 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, if surgery well moulded into the arch with the foot plantigrade is undertaken it applied. Partial weight bearing till the 8th week and later full weight bearing is important that it address allowed. When the underlying source of cast is being removed can start building up the patients painROM to counter atrophy and other physical therapy treatment which include stretching and strengthening exercises.