ACCESSORY NAVICULAR SYNDROME
WHAT IS IT?
People who have an accessory navicular often are unaware of the condition if it causes no problems. However, some people with this extra bone develop a painful condition known as accessory navicular syndrome when the bone and/or posterior tibial tendon are aggravated. This can result from any of the following:
- Trauma, as in a foot or ankle sprain
- Chronic irritation from shoes or other footwear rubbing against the extra bone
- Excessive activity or overuse
Many people with accessory navicular syndrome also have flat feet (fallen arches). Having a flat foot puts more strain on the posterior tibial tendon, which can produce inflammation or irritation of the accessory navicular.
SYMPTOMS
Adolescence is a common time for the symptoms to first appear. This is a time when bones are maturing and cartilage is developing into bone. Sometimes, however, the symptoms do not occur until adulthood. The signs and symptoms of accessory navicular syndrome include:
A visible bony prominence on the midfoot (the inner side of the foot, just above the arch) Redness and swelling of the bony prominence Vague pain or throbbing in the midfoot and arch, usually occurring during or after periods of activity
TREATMENT
The goal of nonsurgical treatment for accessory navicular syndrome is to relieve the symptoms. The following may be used:
- Immobilization. Placing the foot in a cast or removable walking boot allows the affected area to rest and decreases the inflammation.
- Ice. To reduce swelling, a bag of ice covered with a thin towel is applied to the aected area. Do not put ice directly on the skin.
- Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be prescribed. In some cases, oral or injected steroid medications may be used in combination with immobilization to reduce pain and inflammation.
- Physical therapy. Physical therapy may be prescribed, including exercises and treatments to strengthen the muscles and decrease inflammation. The exercises may also help prevent recurrence of the symptoms.
- Orthotic devices. Custom orthotic devices that fit into the shoe provide support for the arch and may play a role in preventing future symptoms.
Even after successful treatment, the symptoms of accessory navicular syndrome sometimes reappear. When this happens, nonsurgical approaches are usually repeated.
When Is Surgery Needed?
If nonsurgical treatment fails to relieve the symptoms of accessory navicular syndrome, surgery may be appropriate. Surgery may involve removing the accessory bone, reshaping the area and repairing the posterior tibial tendon to improve its function. This extra bone is not needed for normal foot function.
WHY CHOOSE A FOOT AND ANKLE SURGEON?
Foot and ankle surgeons are the leading experts in foot and ankle care today. As doctors of podiatric medicine – also known as podiatrists, DPMs or occasionally “foot and ankle doctors” – they are the board-certified surgical specialists of the podiatric profession. Foot and ankle surgeons have more education and training specific to the foot and ankle than any other healthcare provider.
Foot and ankle surgeons treat all conditions affecting the foot and ankle, from the simple to the complex, in patients of all ages including Haglund's deformity. Their intensive education and training qualify foot and ankle surgeons to perform a wide range of surgeries, including any surgery that may be indicated for Haglund's deformity.
