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Overview<br>The An accessory navicular bone is an ossicle, or extra accessory bone located medially to of the foot that occasionally develops abnormally in front of the ankle towards the inside of the navicularfoot. Depending on the type, or stage, it This bone may be connected to present in approximately 2-14% of the navicular by a fibrous union, via a type of joint called a synchrondrosisgeneral population and is usually asymptomatic. In those who have this extra bone, When it is present at birthsymptomatic, but it starts as soft cartilage and then begins to ossify (turn into bone) surgery may be necessary. Surgery can be performed at around any age nine. Some sources believe that, in about half of those who have because it, the bone will fuse to the navicular in late adolescence, but it is does not clear that this actually happensalter any other bones.<br><br><br><br>Causes<br>It Most of the time, this condition is commonly believed asymptomatic and people may live their whole lives unaware that they even have this extra bone. The main reason the posterior tibial tendon loses its vector of pull to heighten the archaccessory navicular bone becomes problematic is when pain occurs. As the posterior muscle contracts, the tendon There is no need for intervention if there is no longer pulling straight up on the pain. The accessory navicular but must course around bone is easily felt in the medial arch because it forms a bony prominence of bone and first pull medially before pulling upwardthere. In addition, the enlarged bones Pain may irritate and damage the insertional area of the posterior tibial tendon, making it less functional. Therefore, the presence of occur if the accessory navicular bone does contribute is overly large causing this bump on the instep to posterior tibial dysfunctionrub against footwear.<br><br>Symptoms<br>Symptoms of this This painful condition is called accessory navicular syndrome would include redness, swelling and tenderness over the navicular bone. The Accessory navicular bone is located on the inside of syndrome (ANS) can cause significant pain in the mid-foot approximately midway between the ankle bone and big toe jointarch, especially with activity. It will tend Redness and swelling may develop over this bony prominence, as well as extreme sensitivity to pressure. Sometimes people may be worse after activity and can be aggravated by those that unable to wear very dressy shoes as opposed to casual shoes like sneakers. In other words, because the flatter or less supportive the shoe, the greater the chance for painarea is too sensitive.<br><br>Diagnosis<br>To diagnose Plain x-rays are used to determine the size of the accessory navicular syndrome, medical staff ask about the patient?s activities and symptoms. They will examine the foot for irritation or swelling. Medical staff There are three main types of accessory navicular bones: evaluate a small bone embedded within the nearby posterior tibial tendon; a triangular shaped bone structure, muscle, joint motion, connected to the navicular by thick cartilage; and a large prominent navicular tuberosity thought to represent an accessory navicular that has fused to the patient?s gaitnavicular. X-rays can usually confirm If the status of the diagnosis. MRI posterior tibial tendon needs to be assessed or if other imaging tests problems are suspected, (ex. Navicular stress fracture) it may be used necessary to determine any perform an MRI. Although this is not considered routine, an MRI may be helpful in identifying the degree of irritation . An MRI would demonstrate fluid or damage to soft-tissue structures such edema that may accumulate in the bone as tendons or ligaments. Because navicular accessory bone a result of the irritation can lead to bunions, [http://Isadorakraemer.blog.fc2.com/blog-entry-34.html heel spurs] and plantar fasciitis, it?s important to seek treatment.<br><br>Non Surgical Treatment<br>The goal of non-surgical treatment Aside from surgery, there are a few options for handling an accessory navicular syndrome is to relieve the symptomsbone that has become symptomatic. The following may be usedThis includes immobilization, icing, medicating, physical therapy, and orthotic devices. Immobilization. Placing Immobilizing involves placing the foot and ankle in a cast or removable walking boot allows . This alleviates stressors on the affected area to rest foot and decreases the can decrease inflammation. Ice. To Icing will help reduce swelling, a bag and inflammation. Medication involves usage of ice covered with a thin towel is applied to the affected area. Do not put ice directly on the skin. Oral nonsteroidal anti-inflammatory drugs , or steroids (NSAIDs), such as ibuprofen, may be prescribed. In some cases, oral taken orally or injected steroid medications may be used in combination with immobilization ) to reduce pain and decrease inflammation. Physical therapy may can be prescribed, including exercises and treatments in order to strengthen the muscles and help decrease inflammation. The exercises may Physical therapy can also help prevent recurrence of the symptomsfrom returning. Custom orthotic Orthotic devices (arch support devices that fit into the in a shoe provide support for the arch, and may play a role in preventing ) can help prevent future symptoms. Even after successful treatmentOccasionally, the symptoms orthotic device will dig into the edge of the accessory navicular syndrome sometimes reappearand cause discomfort. When For this happensreason, non-surgical approaches are usually repeatedthe orthotic devices made for the patient should be carefully constructed.<br><br><br><br>Surgical Treatment<br>If all nonsurgical measures fail and Depending upon the severity the fragment continues to non operative or conservative treatment should be painful, surgery may maintained for at least 4- 6 months before any surgical intervention. There are 2 surgeries that can be recommendedperformed depending upon the condition and symptoms. First is simple surgical excision. In this generally the accessory navicular along with its prominence is removed. The most common In this procedure used , skin incision is made dorsally to treat the symptomatic prominence of accessory navicular . Bone is removed to the Kidner procedurepoint [http://catinaturomsha.jigsy. A small incision com/entries/general/heel-discomfort-the-causes-warning-signs-and-therapy-choices Where is made in the instep of Achilles heel?] the medial foot has no bony prominence over the accessory navicular, between the head of the talus and first cuneiform. Symptoms are relieved in 90% of cases. The accessory Second is Kindler procedure. In this the ossicle and navicular prominence is then detached from excised as in simple excision but along with the posterior tibial tendon and removed from the footadvancement. The posterior Posterior tibial tendon is reattached split and advanced along the medial side of foot to provide support to the remaining normal navicularlongitudinal arch. Following After surgery 4 week short leg cast, well moulded into the procedure, arch with the skin incision foot plantigrade is closed with stitches, and a bulky bandage and splint are applied to . Partial weight bearing till the foot 8th week and anklelater full weight bearing is allowed. You may need to use crutches for several days after surgery. Your stitches will be When the cast is being removed in 10 can start building up the ROM to 14 days (unless they are the absorbable type, counter atrophy and other physical therapy treatment which will not need to be taken out). You should be safe to be released to full activity in about six weeksinclude stretching and strengthening exercises.<br><br>Th1s1sanart1cl3s1te