http://www.rehime.com.ar/bases/paginasdecine/index.php?title=Extra_Bone_In_Foot_Accessory_Navicular&feed=atom&action=historyExtra Bone In Foot Accessory Navicular - Historial de revisiones2024-03-28T22:08:00ZHistorial de revisiones para esta página en el wikiMediaWiki 1.24.1http://www.rehime.com.ar/bases/paginasdecine/index.php?title=Extra_Bone_In_Foot_Accessory_Navicular&diff=12792&oldid=prevPeteVanwinkle en 09:30 12 jun 20172017-06-12T09:30:40Z<p></p>
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<td colspan='2' style="background-color: white; color:black; text-align: center;">Revisión de 09:30 12 jun 2017</td>
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<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>Overview<br>The accessory navicular is <del class="diffchange diffchange-inline">a congenital anomaly, meaning that you are born with the </del>extra bone<del class="diffchange diffchange-inline">. As </del>the <del class="diffchange diffchange-inline">skeleton completely matures, </del>the <del class="diffchange diffchange-inline">navicular </del>and <del class="diffchange diffchange-inline">the </del>accessory navicular never <del class="diffchange diffchange-inline">completely grow</del>, or <del class="diffchange diffchange-inline">fuse</del>, <del class="diffchange diffchange-inline">into one solid bone. The two bones are joined by fibrous tissue or cartilage. Girls seem </del>to <del class="diffchange diffchange-inline">be more likely to have an accessory navicular than boys</del>.<br><br><br><br>Causes<br><del class="diffchange diffchange-inline">Let us see </del>the <del class="diffchange diffchange-inline">reasons why </del>the <del class="diffchange diffchange-inline">tendon or the bone would get aggravated</del>. <del class="diffchange diffchange-inline">Ankle or foot sprain, irritation of </del>the <del class="diffchange diffchange-inline">bone caused by footwear, overusing </del>the <del class="diffchange diffchange-inline">foot, quite common in athletes </del>and <del class="diffchange diffchange-inline">dancers</del>. <del class="diffchange diffchange-inline">People born with this extra bone are also known develop flat feet which also adds </del>to <del class="diffchange diffchange-inline">the strain on </del>the posterior tibial tendon <del class="diffchange diffchange-inline">and lead </del>to the <del class="diffchange diffchange-inline">syndrome</del>.<br><br>Symptoms<br><del class="diffchange diffchange-inline">Adolescence is a common time for </del>the <del class="diffchange diffchange-inline">symptoms to first appear</del>. <del class="diffchange diffchange-inline">This is </del>a <del class="diffchange diffchange-inline">time when bones are maturing and cartilage is developing into bone</del>. <del class="diffchange diffchange-inline">Sometimes</del>, <del class="diffchange diffchange-inline">however</del>, <del class="diffchange diffchange-inline">the symptoms do not occur until adulthood. The signs and symptoms of accessory navicular syndrome </del>include <del class="diffchange diffchange-inline">A visible bony prominence on </del>the <del class="diffchange diffchange-inline">midfoot (the inner side </del>of <del class="diffchange diffchange-inline">the foot, just above </del>the arch<del class="diffchange diffchange-inline">) Redness </del>and <del class="diffchange diffchange-inline">swelling </del>of the <del class="diffchange diffchange-inline">bony prominence</del>. <del class="diffchange diffchange-inline">Vague pain or throbbing </del>in <del class="diffchange diffchange-inline">the midfoot </del>and <del class="diffchange diffchange-inline">arch, usually occurring during </del>or after <del class="diffchange diffchange-inline">periods of activity</del>.<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://<del class="diffchange diffchange-inline">gentlewidget6813</del>.<del class="diffchange diffchange-inline">jimdo</del>.com/2015/06/<del class="diffchange diffchange-inline">25/contracted-toe-tendon-pain </del>heel spurs] and plantar fasciitis, it?s important to seek treatment.<br><br>Non Surgical Treatment<br><del class="diffchange diffchange-inline">For less severe symptoms, decreasing or modifying activity</del>, such as <del class="diffchange diffchange-inline">avoiding aggravating activities</del>, <del class="diffchange diffchange-inline">may suffice</del>. <del class="diffchange diffchange-inline">Ice and NSAIDS can be used </del>to <del class="diffchange diffchange-inline">help </del>control <del class="diffchange diffchange-inline">pain. An arch support or an orthotics may help to stabilize </del>the <del class="diffchange diffchange-inline">arch during this time. When rubbing on the bump causes </del>pain<del class="diffchange diffchange-inline">, a doughnut pad can be worn. Exercises to increase range of motion and improve movement should still be used</del>.<br><br><br><br>Surgical Treatment<br><del class="diffchange diffchange-inline">Depending upon </del>the <del class="diffchange diffchange-inline">severity the non operative or conservative treatment should </del>be <del class="diffchange diffchange-inline">maintained for at least 4- 6 months before any surgical intervention. There are 2 surgeries that can </del>be <del class="diffchange diffchange-inline">performed depending upon the condition and symptoms</del>. <del class="diffchange diffchange-inline">First is simple surgical excision. In this generally </del>the accessory navicular <del class="diffchange diffchange-inline">along with its prominence </del>is <del class="diffchange diffchange-inline">removed</del>. <del class="diffchange diffchange-inline">In this procedure, skin </del>incision is made <del class="diffchange diffchange-inline">dorsally to </del>the <del class="diffchange diffchange-inline">prominence </del>of <del class="diffchange diffchange-inline">accessory navicular. Bone is removed to the point where </del>the <del class="diffchange diffchange-inline">medial </del>foot <del class="diffchange diffchange-inline">has no bony prominence </del>over the navicular<del class="diffchange diffchange-inline">, between the head of the talus and first cuneiform</del>. <del class="diffchange diffchange-inline">Symptoms are relieved in 90% of cases. Second is Kindler procedure. In this the ossicle and </del>navicular <del class="diffchange diffchange-inline">prominence </del>is <del class="diffchange diffchange-inline">excised as in simple excision but along with </del>the posterior tibial tendon <del class="diffchange diffchange-inline">advancement</del>. <del class="diffchange diffchange-inline">Posterior </del>tibial tendon is <del class="diffchange diffchange-inline">split and advanced along the medial side of foot </del>to <del class="diffchange diffchange-inline">provide support to longitudinal arch</del>. <del class="diffchange diffchange-inline">After surgery 4 week short leg cast</del>, <del class="diffchange diffchange-inline">well moulded into </del>the <del class="diffchange diffchange-inline">arch with the foot plantigrade </del>is applied<del class="diffchange diffchange-inline">. Partial weight bearing till </del>the <del class="diffchange diffchange-inline">8th week </del>and <del class="diffchange diffchange-inline">later full weight bearing is allowed</del>. <del class="diffchange diffchange-inline">When the cast is being </del>removed <del class="diffchange diffchange-inline">can start building up the ROM </del>to <del class="diffchange diffchange-inline">counter atrophy and other physical therapy treatment </del>which <del class="diffchange diffchange-inline">include stretching and strengthening exercises</del>.</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>Overview<br>The accessory navicular is <ins class="diffchange diffchange-inline">an </ins>extra <ins class="diffchange diffchange-inline">piece of cartilage or </ins>bone <ins class="diffchange diffchange-inline">on </ins>the <ins class="diffchange diffchange-inline">inner side of </ins>the <ins class="diffchange diffchange-inline">foot. It is found in about 10 percent of individuals </ins>and <ins class="diffchange diffchange-inline">is present at birth. Many people who have an </ins>accessory navicular <ins class="diffchange diffchange-inline">are </ins>never <ins class="diffchange diffchange-inline">aware of it because they do not experience symptoms. However</ins>, <ins class="diffchange diffchange-inline">aggravation of the accessory navicular </ins>or <ins class="diffchange diffchange-inline">the posterior tibia tendon</ins>, <ins class="diffchange diffchange-inline">which it is attached </ins>to<ins class="diffchange diffchange-inline">, can develop as a result of trauma, irritation from shoes, and excessive overuse</ins>.<br><br><br><br>Causes<br><ins class="diffchange diffchange-inline">An injury to </ins>the <ins class="diffchange diffchange-inline">fibrous tissue connecting </ins>the <ins class="diffchange diffchange-inline">two bones can cause something similar to a fracture</ins>. <ins class="diffchange diffchange-inline">The injury allows movement to occur between </ins>the <ins class="diffchange diffchange-inline">navicular and </ins>the <ins class="diffchange diffchange-inline">accessory bone </ins>and <ins class="diffchange diffchange-inline">is thought to be the cause of pain</ins>. <ins class="diffchange diffchange-inline">The fibrous tissue is prone </ins>to <ins class="diffchange diffchange-inline">poor healing and may continue to cause pain. Because </ins>the posterior tibial tendon <ins class="diffchange diffchange-inline">attaches </ins>to the <ins class="diffchange diffchange-inline">accessory navicular, it constantly pulls on the bone, creating even more motion between the fragments with each step</ins>.<br><br>Symptoms<br><ins class="diffchange diffchange-inline">What precipitates </ins>the <ins class="diffchange diffchange-inline">pain? It will usually be caused by rubbing of the skate or other footwear against the prominence</ins>. <ins class="diffchange diffchange-inline">You?ll commonly see blisters or </ins>a <ins class="diffchange diffchange-inline">red irritated area</ins>. <ins class="diffchange diffchange-inline">Other symptoms to look for</ins>, <ins class="diffchange diffchange-inline">especially when you?re treating an older child or adult</ins>, include <ins class="diffchange diffchange-inline">an area of pain along </ins>the <ins class="diffchange diffchange-inline">posterior tibial tendon </ins>of the arch and <ins class="diffchange diffchange-inline">fatigue </ins>of the <ins class="diffchange diffchange-inline">legs</ins>. <ins class="diffchange diffchange-inline">Typically, these patients are not able to participate </ins>in <ins class="diffchange diffchange-inline">sports for a lengthy period of time or you?ll hear them complain of pain </ins>and<ins class="diffchange diffchange-inline">/</ins>or <ins class="diffchange diffchange-inline">soreness </ins>after <ins class="diffchange diffchange-inline">extended activities. Most individuals with a prominent navicular area will have tried accommodating this area with a doughnut pad or adjustments to their skate</ins>.<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://<ins class="diffchange diffchange-inline">rosiasearer</ins>.<ins class="diffchange diffchange-inline">hatenablog</ins>.com<ins class="diffchange diffchange-inline">/entries</ins>/2015/06/<ins class="diffchange diffchange-inline">28 </ins>heel spurs] and plantar fasciitis, it?s important to seek treatment.<br><br>Non Surgical Treatment<br><ins class="diffchange diffchange-inline">The treatment for a symptomatic accessory navicular can be divided into nonsurgical treatment and surgical treatment. In the vast majority of cases</ins>, <ins class="diffchange diffchange-inline">treatment usually begins with nonsurgical measures </ins>such as <ins class="diffchange diffchange-inline">orthotics</ins>, <ins class="diffchange diffchange-inline">strappings or bracing</ins>. <ins class="diffchange diffchange-inline">Surgery usually is only considered when all nonsurgical measures have failed </ins>to control <ins class="diffchange diffchange-inline">your problem and </ins>the pain <ins class="diffchange diffchange-inline">becomes intolerable</ins>.<br><br><br><br>Surgical Treatment<br><ins class="diffchange diffchange-inline">If all nonsurgical measures fail and </ins>the <ins class="diffchange diffchange-inline">fragment continues to </ins>be <ins class="diffchange diffchange-inline">painful, surgery may </ins>be <ins class="diffchange diffchange-inline">recommended</ins>. <ins class="diffchange diffchange-inline">The most common procedure used to treat </ins>the <ins class="diffchange diffchange-inline">symptomatic </ins>accessory navicular is <ins class="diffchange diffchange-inline">the Kidner procedure</ins>. <ins class="diffchange diffchange-inline">A small </ins>incision is made <ins class="diffchange diffchange-inline">in </ins>the <ins class="diffchange diffchange-inline">instep </ins>of the foot over the <ins class="diffchange diffchange-inline">accessory </ins>navicular. <ins class="diffchange diffchange-inline">The accessory </ins>navicular is <ins class="diffchange diffchange-inline">then detached from </ins>the posterior tibial tendon <ins class="diffchange diffchange-inline">and removed from the foot</ins>. <ins class="diffchange diffchange-inline">The posterior </ins>tibial tendon is <ins class="diffchange diffchange-inline">reattached </ins>to <ins class="diffchange diffchange-inline">the remaining normal navicular</ins>. <ins class="diffchange diffchange-inline">Following the procedure</ins>, the <ins class="diffchange diffchange-inline">skin incision </ins>is <ins class="diffchange diffchange-inline">closed with stitches, and a bulky bandage and splint are </ins>applied <ins class="diffchange diffchange-inline">to </ins>the <ins class="diffchange diffchange-inline">foot </ins>and <ins class="diffchange diffchange-inline">ankle</ins>. <ins class="diffchange diffchange-inline">You may need to use crutches for several days after surgery. Your stitches will be </ins>removed <ins class="diffchange diffchange-inline">in 10 </ins>to <ins class="diffchange diffchange-inline">14 days (unless they are the absorbable type, </ins>which <ins class="diffchange diffchange-inline">will not need to be taken out). You should be safe to be released to full activity in about six weeks</ins>.</div></td></tr>
</table>PeteVanwinklehttp://www.rehime.com.ar/bases/paginasdecine/index.php?title=Extra_Bone_In_Foot_Accessory_Navicular&diff=12732&oldid=prevRainaHanslow en 06:43 12 jun 20172017-06-12T06:43:38Z<p></p>
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<td colspan='2' style="background-color: white; color:black; text-align: center;">Revisión de 06:43 12 jun 2017</td>
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<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>Overview<br><del class="diffchange diffchange-inline">An </del>accessory navicular is <del class="diffchange diffchange-inline">defined as an </del>extra bone <del class="diffchange diffchange-inline">in </del>the <del class="diffchange diffchange-inline">foot</del>, and <del class="diffchange diffchange-inline">oftentimes it causes moderate to severe discomfort.  Depending on </del>the <del class="diffchange diffchange-inline">severity</del>, <del class="diffchange diffchange-inline">your doctor may recommend a non-surgical treatment to alleviate the pain</del>, or <del class="diffchange diffchange-inline">surgery if treatment doesn?t decrease symptoms</del>.<br><br><br><br>Causes<br><del class="diffchange diffchange-inline">Like all painful conditions, ANS has a root cause. The cause could be </del>the <del class="diffchange diffchange-inline">accessory navicular bone itself producing irritation from shoes </del>or <del class="diffchange diffchange-inline">too much activity</del>. <del class="diffchange diffchange-inline">Often</del>, <del class="diffchange diffchange-inline">however, it is related to injury of one </del>of the <del class="diffchange diffchange-inline">structures that attach to the navicular </del>bone. <del class="diffchange diffchange-inline">Structures that attach </del>to the <del class="diffchange diffchange-inline">navicular bone include abductor hallucis muscle, plantar calcaneonavicular ligament (spring ligament) parts of </del>the <del class="diffchange diffchange-inline">deltoid ligament, </del>posterior tibial tendon.<br><br>Symptoms<br><del class="diffchange diffchange-inline">The catalyst </del>for symptoms <del class="diffchange diffchange-inline">might be some sort of injury (such as </del>a <del class="diffchange diffchange-inline">broken or sprained ankle)</del>, <del class="diffchange diffchange-inline">excessive activity</del>, <del class="diffchange diffchange-inline">or irritation from where shoes are rubbing on </del>the bony prominence the <del class="diffchange diffchange-inline">accessory navicular makes. These can irritate </del>the <del class="diffchange diffchange-inline">bone</del>, <del class="diffchange diffchange-inline">or make </del>the <del class="diffchange diffchange-inline">tendon it?s embedded in (the posterior tibial tendon, remember?</del>) <del class="diffchange diffchange-inline">inflamed </del>and <del class="diffchange diffchange-inline">sore</del>. <del class="diffchange diffchange-inline">Because the tendon is compromised </del>in <del class="diffchange diffchange-inline">its ability to support </del>the arch, <del class="diffchange diffchange-inline">accessory navicular syndrome almost always leads to flat feet, which is one very obvious symptom</del>.<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://<del class="diffchange diffchange-inline">wayne4Tran</del>.jimdo.com/2015/06/<del class="diffchange diffchange-inline">26</del>/<del class="diffchange diffchange-inline">hammer</del>-toe-<del class="diffchange diffchange-inline">symptoms </del>heel spurs] and plantar fasciitis, it?s important to seek treatment.<br><br>Non Surgical Treatment<br><del class="diffchange diffchange-inline">Initial treatment is conservative. With the first episode of </del>symptoms, <del class="diffchange diffchange-inline">a medial heel wedge</del>, <del class="diffchange diffchange-inline">anti-inflammatories</del>, and <del class="diffchange diffchange-inline">physical therapy </del>can be <del class="diffchange diffchange-inline">helpful</del>. <del class="diffchange diffchange-inline">If very painful, a cast </del>or <del class="diffchange diffchange-inline">boot </del>may <del class="diffchange diffchange-inline">be needed for a short period </del>time <del class="diffchange diffchange-inline">before the wedge and physical therapy can be initiated</del>. <del class="diffchange diffchange-inline">Very rarely is a steroid injection warranted or recommended. As </del>the pain <del class="diffchange diffchange-inline">improves</del>, <del class="diffchange diffchange-inline">patients can resume activities. For </del>a <del class="diffchange diffchange-inline">minority of patients, an arch support or custom orthotic </del>can <del class="diffchange diffchange-inline">help </del>to <del class="diffchange diffchange-inline">take some </del>of <del class="diffchange diffchange-inline">the extra pressure off of the accessory navicular </del>and <del class="diffchange diffchange-inline">the posterior tibial tendon</del>.<br><br><br><br>Surgical Treatment<br><del class="diffchange diffchange-inline">Once </del>the <del class="diffchange diffchange-inline">navicular inflammation has lessened it is not necessary to perform surgery unless </del>the <del class="diffchange diffchange-inline">foot becomes progressively flatter </del>or <del class="diffchange diffchange-inline">continues to </del>be <del class="diffchange diffchange-inline">painful</del>. <del class="diffchange diffchange-inline">For these children, surgery </del>can <del class="diffchange diffchange-inline">completely correct </del>the <del class="diffchange diffchange-inline">problem by removing </del>the accessory navicular <del class="diffchange diffchange-inline">bone and tightening up </del>the <del class="diffchange diffchange-inline">posterior tibial tendon that attaches </del>to the navicular <del class="diffchange diffchange-inline">bone</del>. <del class="diffchange diffchange-inline">The strength </del>of this tendon is <del class="diffchange diffchange-inline">integral to </del>the <del class="diffchange diffchange-inline">success </del>of <del class="diffchange diffchange-inline">this </del>surgery <del class="diffchange diffchange-inline">as </del>well <del class="diffchange diffchange-inline">as </del>the arch <del class="diffchange diffchange-inline">of </del>the foot. <del class="diffchange diffchange-inline">Following surgery </del>the <del class="diffchange diffchange-inline">child </del>is <del class="diffchange diffchange-inline">able to begin walking on </del>the <del class="diffchange diffchange-inline">foot (in a cast) at approximately two weeks. The </del>cast is <del class="diffchange diffchange-inline">worn for an additional four weeks. A small soft ankle support brace is then put into </del>the <del class="diffchange diffchange-inline">shoe </del>and <del class="diffchange diffchange-inline">worn with activities </del>and <del class="diffchange diffchange-inline">exercise for a further two months</del>.</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>Overview<br><ins class="diffchange diffchange-inline">The </ins>accessory navicular is <ins class="diffchange diffchange-inline">a congenital anomaly, meaning that you are born with the </ins>extra bone<ins class="diffchange diffchange-inline">. As </ins>the <ins class="diffchange diffchange-inline">skeleton completely matures</ins>, <ins class="diffchange diffchange-inline">the navicular </ins>and the <ins class="diffchange diffchange-inline">accessory navicular never completely grow</ins>, <ins class="diffchange diffchange-inline">or fuse</ins>, <ins class="diffchange diffchange-inline">into one solid bone. The two bones are joined by fibrous tissue </ins>or <ins class="diffchange diffchange-inline">cartilage. Girls seem to be more likely to have an accessory navicular than boys</ins>.<br><br><br><br>Causes<br><ins class="diffchange diffchange-inline">Let us see </ins>the <ins class="diffchange diffchange-inline">reasons why the tendon </ins>or <ins class="diffchange diffchange-inline">the bone would get aggravated</ins>. <ins class="diffchange diffchange-inline">Ankle or foot sprain</ins>, <ins class="diffchange diffchange-inline">irritation </ins>of the bone <ins class="diffchange diffchange-inline">caused by footwear, overusing the foot, quite common in athletes and dancers</ins>. <ins class="diffchange diffchange-inline">People born with this extra bone are also known develop flat feet which also adds </ins>to the <ins class="diffchange diffchange-inline">strain on </ins>the posterior tibial tendon <ins class="diffchange diffchange-inline">and lead to the syndrome</ins>.<br><br>Symptoms<br><ins class="diffchange diffchange-inline">Adolescence is a common time </ins>for <ins class="diffchange diffchange-inline">the </ins>symptoms <ins class="diffchange diffchange-inline">to first appear. This is </ins>a <ins class="diffchange diffchange-inline">time when bones are maturing and cartilage is developing into bone. Sometimes</ins>, <ins class="diffchange diffchange-inline">however</ins>, the <ins class="diffchange diffchange-inline">symptoms do not occur until adulthood. The signs and symptoms of accessory navicular syndrome include A visible </ins>bony prominence <ins class="diffchange diffchange-inline">on </ins>the <ins class="diffchange diffchange-inline">midfoot (</ins>the <ins class="diffchange diffchange-inline">inner side of the foot</ins>, <ins class="diffchange diffchange-inline">just above </ins>the <ins class="diffchange diffchange-inline">arch</ins>) <ins class="diffchange diffchange-inline">Redness </ins>and <ins class="diffchange diffchange-inline">swelling of the bony prominence</ins>. <ins class="diffchange diffchange-inline">Vague pain or throbbing </ins>in the <ins class="diffchange diffchange-inline">midfoot and </ins>arch, <ins class="diffchange diffchange-inline">usually occurring during or after periods of activity</ins>.<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://<ins class="diffchange diffchange-inline">gentlewidget6813</ins>.jimdo.com/2015/06/<ins class="diffchange diffchange-inline">25</ins>/<ins class="diffchange diffchange-inline">contracted</ins>-toe-<ins class="diffchange diffchange-inline">tendon-pain </ins>heel spurs] and plantar fasciitis, it?s important to seek treatment.<br><br>Non Surgical Treatment<br><ins class="diffchange diffchange-inline">For less severe </ins>symptoms, <ins class="diffchange diffchange-inline">decreasing or modifying activity</ins>, <ins class="diffchange diffchange-inline">such as avoiding aggravating activities</ins>, <ins class="diffchange diffchange-inline">may suffice. Ice </ins>and <ins class="diffchange diffchange-inline">NSAIDS </ins>can be <ins class="diffchange diffchange-inline">used to help control pain</ins>. <ins class="diffchange diffchange-inline">An arch support </ins>or <ins class="diffchange diffchange-inline">an orthotics </ins>may <ins class="diffchange diffchange-inline">help to stabilize the arch during this </ins>time. <ins class="diffchange diffchange-inline">When rubbing on </ins>the <ins class="diffchange diffchange-inline">bump causes </ins>pain, a <ins class="diffchange diffchange-inline">doughnut pad </ins>can <ins class="diffchange diffchange-inline">be worn. Exercises </ins>to <ins class="diffchange diffchange-inline">increase range </ins>of <ins class="diffchange diffchange-inline">motion </ins>and <ins class="diffchange diffchange-inline">improve movement should still be used</ins>.<br><br><br><br>Surgical Treatment<br><ins class="diffchange diffchange-inline">Depending upon </ins>the <ins class="diffchange diffchange-inline">severity </ins>the <ins class="diffchange diffchange-inline">non operative </ins>or <ins class="diffchange diffchange-inline">conservative treatment should </ins>be <ins class="diffchange diffchange-inline">maintained for at least 4- 6 months before any surgical intervention</ins>. <ins class="diffchange diffchange-inline">There are 2 surgeries that </ins>can <ins class="diffchange diffchange-inline">be performed depending upon </ins>the <ins class="diffchange diffchange-inline">condition and symptoms. First is simple surgical excision. In this generally </ins>the accessory navicular <ins class="diffchange diffchange-inline">along with its prominence is removed. In this procedure, skin incision is made dorsally to </ins>the <ins class="diffchange diffchange-inline">prominence of accessory navicular. Bone is removed </ins>to <ins class="diffchange diffchange-inline">the point where the medial foot has no bony prominence over </ins>the navicular<ins class="diffchange diffchange-inline">, between the head of the talus and first cuneiform</ins>. <ins class="diffchange diffchange-inline">Symptoms are relieved in 90% </ins>of <ins class="diffchange diffchange-inline">cases. Second is Kindler procedure. In </ins>this <ins class="diffchange diffchange-inline">the ossicle and navicular prominence is excised as in simple excision but along with the posterior tibial tendon advancement. Posterior tibial </ins>tendon is <ins class="diffchange diffchange-inline">split and advanced along </ins>the <ins class="diffchange diffchange-inline">medial side </ins>of <ins class="diffchange diffchange-inline">foot to provide support to longitudinal arch. After </ins>surgery <ins class="diffchange diffchange-inline">4 week short leg cast, </ins>well <ins class="diffchange diffchange-inline">moulded into </ins>the arch <ins class="diffchange diffchange-inline">with </ins>the foot <ins class="diffchange diffchange-inline">plantigrade is applied</ins>. <ins class="diffchange diffchange-inline">Partial weight bearing till </ins>the <ins class="diffchange diffchange-inline">8th week and later full weight bearing </ins>is <ins class="diffchange diffchange-inline">allowed. When </ins>the cast is <ins class="diffchange diffchange-inline">being removed can start building up </ins>the <ins class="diffchange diffchange-inline">ROM to counter atrophy </ins>and <ins class="diffchange diffchange-inline">other physical therapy treatment which include stretching </ins>and <ins class="diffchange diffchange-inline">strengthening exercises</ins>.</div></td></tr>
</table>RainaHanslowhttp://www.rehime.com.ar/bases/paginasdecine/index.php?title=Extra_Bone_In_Foot_Accessory_Navicular&diff=12384&oldid=prevReinaHightower1 en 01:05 12 jun 20172017-06-12T01:05:52Z<p></p>
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<td colspan='2' style="background-color: white; color:black; text-align: center;">Revisión de 01:05 12 jun 2017</td>
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<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>Overview<br><del class="diffchange diffchange-inline">Accessory navicular syndrome occurs when a type II </del>accessory navicular <del class="diffchange diffchange-inline">(or "os tibiale externum") becomes painful due to movement across the pseudojoint between the ossicle and the navicular </del>bone<del class="diffchange diffchange-inline">. The syndrome presents on MRI with bone marrow oedema signal (hypointense T1, hyperintense T2/STIR) </del>in <del class="diffchange diffchange-inline">both </del>the <del class="diffchange diffchange-inline">accessory ossicle </del>and <del class="diffchange diffchange-inline">navicular</del>. <del class="diffchange diffchange-inline">It can be inferred </del>on <del class="diffchange diffchange-inline">musculoskeletal ultrasound if </del>a <del class="diffchange diffchange-inline">patient's pain is located at a type II accessory navicular and the patient is tender </del>to <del class="diffchange diffchange-inline">transducer pressure. Ultrasound can also be useful to compare with </del>the <del class="diffchange diffchange-inline">contralateral side</del>.<br><br><br><br>Causes<br>Like all painful conditions, ANS has a root cause. The cause could be the accessory navicular bone itself producing irritation from shoes or too much activity. Often, however, it is related to injury of one of the structures that attach to the navicular bone. Structures that attach to the navicular bone include abductor hallucis muscle, plantar calcaneonavicular ligament (spring ligament) parts of the deltoid ligament, posterior tibial tendon.<br><br>Symptoms<br><del class="diffchange diffchange-inline">Adolescence is a common time </del>for <del class="diffchange diffchange-inline">the </del>symptoms <del class="diffchange diffchange-inline">to first appear. This is </del>a <del class="diffchange diffchange-inline">time when bones are maturing and cartilage is developing into bone. Sometimes</del>, <del class="diffchange diffchange-inline">however</del>, the <del class="diffchange diffchange-inline">symptoms do not occur until adulthood. The signs and symptoms of accessory navicular syndrome include A visible </del>bony prominence <del class="diffchange diffchange-inline">on </del>the <del class="diffchange diffchange-inline">midfoot </del>(the <del class="diffchange diffchange-inline">inner side of the foot</del>, <del class="diffchange diffchange-inline">just above the arch</del>) <del class="diffchange diffchange-inline">Redness </del>and <del class="diffchange diffchange-inline">swelling of </del>the <del class="diffchange diffchange-inline">bony prominence. Vague pain or throbbing </del>in the <del class="diffchange diffchange-inline">midfoot and </del>arch, <del class="diffchange diffchange-inline">usually occurring during or after periods of activity</del>.<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://<del class="diffchange diffchange-inline">AmmieBaillie</del>.<del class="diffchange diffchange-inline">Bravesites</del>.com/<del class="diffchange diffchange-inline">entries</del>/<del class="diffchange diffchange-inline">general</del>/<del class="diffchange diffchange-inline">Hammer</del>-<del class="diffchange diffchange-inline">Toe</del>-<del class="diffchange diffchange-inline">Pain-Ball-Foot </del>heel spurs] and plantar fasciitis, it?s important to seek treatment.<br><br>Non Surgical Treatment<br><del class="diffchange diffchange-inline">Patients with </del>a <del class="diffchange diffchange-inline">painful accessory navicular may benefit with four to six </del>physical therapy <del class="diffchange diffchange-inline">treatments</del>. <del class="diffchange diffchange-inline">Your therapist may design </del>a <del class="diffchange diffchange-inline">series of stretching exercises to try and ease tension on the posterior tibial tendon. A shoe insert, </del>or <del class="diffchange diffchange-inline">orthotic, </del>may be <del class="diffchange diffchange-inline">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 </del>for <del class="diffchange diffchange-inline">several weeks to allow </del>the <del class="diffchange diffchange-inline">inflammation </del>and <del class="diffchange diffchange-inline">pain to subside</del>. <del class="diffchange diffchange-inline">Treatments directed to </del>the <del class="diffchange diffchange-inline">painful area help control </del>pain <del class="diffchange diffchange-inline">and swelling. Examples include ultrasound</del>, <del class="diffchange diffchange-inline">moist heat, and soft-tissue massage</del>. <del class="diffchange diffchange-inline">Therapy sessions sometimes include iontophoresis, which uses </del>a <del class="diffchange diffchange-inline">mild electrical current to push anti-inflammatory medicine </del>to the <del class="diffchange diffchange-inline">sore area</del>.<br><br><br><br>Surgical Treatment<br><del class="diffchange diffchange-inline">The original procedure advocated </del>by <del class="diffchange diffchange-inline">Kidner involved shelling out of </del>the accessory navicular bone <del class="diffchange diffchange-inline">from within the insertional area of </del>the posterior tibial tendon <del class="diffchange diffchange-inline">and rerouting this tendon under </del>the navicular bone <del class="diffchange diffchange-inline">in hopes of restoring a normal pull </del>of this tendon<del class="diffchange diffchange-inline">. When treating younger children, history has shown us that simply shelling out </del>of the <del class="diffchange diffchange-inline">accessory navicular bone from within the tendon and remodeling the tuberosity </del>of the <del class="diffchange diffchange-inline">navicular bone can give you satisfactory results</del>.<del class="diffchange diffchange-inline"><br>In general, you want </del>to <del class="diffchange diffchange-inline">reserve advancement of </del>the <del class="diffchange diffchange-inline">posterior tibial tendon for adults or those who have </del>a <del class="diffchange diffchange-inline">more significant flatfoot deformity</del>. <del class="diffchange diffchange-inline">You may also use this approach after determining that quality custom orthotics are only resulting in </del>a <del class="diffchange diffchange-inline">slight decrease of symptoms</del>.</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>Overview<br><ins class="diffchange diffchange-inline">An </ins>accessory navicular <ins class="diffchange diffchange-inline">is defined as an extra </ins>bone in the <ins class="diffchange diffchange-inline">foot, </ins>and <ins class="diffchange diffchange-inline">oftentimes it causes moderate to severe discomfort</ins>. <ins class="diffchange diffchange-inline"> Depending </ins>on <ins class="diffchange diffchange-inline">the severity, your doctor may recommend </ins>a <ins class="diffchange diffchange-inline">non-surgical treatment </ins>to <ins class="diffchange diffchange-inline">alleviate </ins>the <ins class="diffchange diffchange-inline">pain, or surgery if treatment doesn?t decrease symptoms</ins>.<br><br><br><br>Causes<br>Like all painful conditions, ANS has a root cause. The cause could be the accessory navicular bone itself producing irritation from shoes or too much activity. Often, however, it is related to injury of one of the structures that attach to the navicular bone. Structures that attach to the navicular bone include abductor hallucis muscle, plantar calcaneonavicular ligament (spring ligament) parts of the deltoid ligament, posterior tibial tendon.<br><br>Symptoms<br><ins class="diffchange diffchange-inline">The catalyst </ins>for symptoms <ins class="diffchange diffchange-inline">might be some sort of injury (such as </ins>a <ins class="diffchange diffchange-inline">broken or sprained ankle)</ins>, <ins class="diffchange diffchange-inline">excessive activity</ins>, <ins class="diffchange diffchange-inline">or irritation from where shoes are rubbing on </ins>the bony prominence the <ins class="diffchange diffchange-inline">accessory navicular makes. These can irritate the bone, or make the tendon it?s embedded in </ins>(the <ins class="diffchange diffchange-inline">posterior tibial tendon</ins>, <ins class="diffchange diffchange-inline">remember?</ins>) <ins class="diffchange diffchange-inline">inflamed </ins>and <ins class="diffchange diffchange-inline">sore. Because </ins>the <ins class="diffchange diffchange-inline">tendon is compromised </ins>in <ins class="diffchange diffchange-inline">its ability to support </ins>the arch, <ins class="diffchange diffchange-inline">accessory navicular syndrome almost always leads to flat feet, which is one very obvious symptom</ins>.<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://<ins class="diffchange diffchange-inline">wayne4Tran</ins>.<ins class="diffchange diffchange-inline">jimdo</ins>.com/<ins class="diffchange diffchange-inline">2015</ins>/<ins class="diffchange diffchange-inline">06</ins>/<ins class="diffchange diffchange-inline">26/hammer</ins>-<ins class="diffchange diffchange-inline">toe</ins>-<ins class="diffchange diffchange-inline">symptoms </ins>heel spurs] and plantar fasciitis, it?s important to seek treatment.<br><br>Non Surgical Treatment<br><ins class="diffchange diffchange-inline">Initial treatment is conservative. With the first episode of symptoms, </ins>a <ins class="diffchange diffchange-inline">medial heel wedge, anti-inflammatories, and </ins>physical therapy <ins class="diffchange diffchange-inline">can be helpful</ins>. <ins class="diffchange diffchange-inline">If very painful, </ins>a <ins class="diffchange diffchange-inline">cast </ins>or <ins class="diffchange diffchange-inline">boot </ins>may be <ins class="diffchange diffchange-inline">needed </ins>for <ins class="diffchange diffchange-inline">a short period time before </ins>the <ins class="diffchange diffchange-inline">wedge </ins>and <ins class="diffchange diffchange-inline">physical therapy can be initiated</ins>. <ins class="diffchange diffchange-inline">Very rarely is a steroid injection warranted or recommended. As </ins>the pain <ins class="diffchange diffchange-inline">improves</ins>, <ins class="diffchange diffchange-inline">patients can resume activities</ins>. <ins class="diffchange diffchange-inline">For </ins>a <ins class="diffchange diffchange-inline">minority of patients, an arch support or custom orthotic can help </ins>to <ins class="diffchange diffchange-inline">take some of </ins>the <ins class="diffchange diffchange-inline">extra pressure off of the accessory navicular and the posterior tibial tendon</ins>.<br><br><br><br>Surgical Treatment<br><ins class="diffchange diffchange-inline">Once the navicular inflammation has lessened it is not necessary to perform surgery unless the foot becomes progressively flatter or continues to be painful. For these children, surgery can completely correct the problem </ins>by <ins class="diffchange diffchange-inline">removing </ins>the accessory navicular bone <ins class="diffchange diffchange-inline">and tightening up </ins>the posterior tibial tendon <ins class="diffchange diffchange-inline">that attaches to </ins>the navicular bone<ins class="diffchange diffchange-inline">. The strength </ins>of this tendon <ins class="diffchange diffchange-inline">is integral to the success </ins>of <ins class="diffchange diffchange-inline">this surgery as well as </ins>the <ins class="diffchange diffchange-inline">arch </ins>of the <ins class="diffchange diffchange-inline">foot</ins>. <ins class="diffchange diffchange-inline">Following surgery the child is able </ins>to <ins class="diffchange diffchange-inline">begin walking on </ins>the <ins class="diffchange diffchange-inline">foot (in </ins>a <ins class="diffchange diffchange-inline">cast) at approximately two weeks</ins>. <ins class="diffchange diffchange-inline">The cast is worn for an additional four weeks. A small soft ankle support brace is then put into the shoe and worn with activities and exercise for </ins>a <ins class="diffchange diffchange-inline">further two months</ins>.</div></td></tr>
</table>ReinaHightower1http://www.rehime.com.ar/bases/paginasdecine/index.php?title=Extra_Bone_In_Foot_Accessory_Navicular&diff=12153&oldid=prevMitchellHeritage en 00:03 12 jun 20172017-06-12T00:03:24Z<p></p>
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<td colspan='2' style="background-color: white; color:black; text-align: center;">Revisión de 00:03 12 jun 2017</td>
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<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>Overview<br><del class="diffchange diffchange-inline">The </del>accessory navicular <del class="diffchange diffchange-inline">also termed the os navicularum </del>or os tibiale externum <del class="diffchange diffchange-inline">- is an extra bone or piece of cartilage on the inner side of the foot above the arch that attaches </del>to the <del class="diffchange diffchange-inline">posterior tibial tendon within this area. This extra bone, present at birth, is not part of </del>the <del class="diffchange diffchange-inline">normal bone structure </del>and <del class="diffchange diffchange-inline">found in approximately 10% of </del>the <del class="diffchange diffchange-inline">population. Some people with an accessory </del>navicular <del class="diffchange diffchange-inline">may be unaware of the condition if symptoms are never experienced</del>. <del class="diffchange diffchange-inline">But accessory navicular </del>syndrome <del class="diffchange diffchange-inline">is a painful condition caused  by aggravating the </del>bone, <del class="diffchange diffchange-inline">the posterior tibial tendon or </del>both<del class="diffchange diffchange-inline">.\Accessory navicular syndrome is an irritation of </del>the accessory navicular <del class="diffchange diffchange-inline">and/or posterior tibial tendon</del>. <del class="diffchange diffchange-inline">This irritation </del>can be <del class="diffchange diffchange-inline">caused by shoe rubbing, trauma, excessive activity, or overuse </del>and <del class="diffchange diffchange-inline">can cause problems with </del>the <del class="diffchange diffchange-inline">shape and function of your foot</del>. <del class="diffchange diffchange-inline">Many people with this disorder </del>also <del class="diffchange diffchange-inline">have flat feet which puts more strain on the posterior tibial tendon. Some people are born </del>with <del class="diffchange diffchange-inline">an accessory Navicular because during development, </del>the <del class="diffchange diffchange-inline">bones of the feet sometimes develop abnormally causing the extra bone to form on the inside of the foot</del>.<br><br><br><br>Causes<br><del class="diffchange diffchange-inline">Most of the time</del>, <del class="diffchange diffchange-inline">this condition is asymptomatic and people may live their whole lives unaware that they even have this extra bone</del>. The <del class="diffchange diffchange-inline">main reason </del>the accessory navicular bone <del class="diffchange diffchange-inline">becomes problematic is when pain occurs</del>. <del class="diffchange diffchange-inline">There </del>is <del class="diffchange diffchange-inline">no need for intervention if there is no pain. The accessory </del>navicular bone <del class="diffchange diffchange-inline">is easily felt in the medial arch because it forms a bony prominence there</del>. <del class="diffchange diffchange-inline">Pain may occur if </del>the <del class="diffchange diffchange-inline">accessory </del>bone <del class="diffchange diffchange-inline">is overly large causing this bump on </del>the <del class="diffchange diffchange-inline">instep to rub against footwear</del>.<br><br>Symptoms<br>This <del class="diffchange diffchange-inline">painful condition </del>is <del class="diffchange diffchange-inline">called </del>accessory navicular syndrome<del class="diffchange diffchange-inline">. Accessory navicular syndrome </del>(<del class="diffchange diffchange-inline">ANS) can cause significant pain in </del>the <del class="diffchange diffchange-inline">mid-</del>foot <del class="diffchange diffchange-inline">and arch</del>, <del class="diffchange diffchange-inline">especially with activity. </del>Redness and swelling <del class="diffchange diffchange-inline">may develop over this </del>bony prominence<del class="diffchange diffchange-inline">, as well as extreme sensitivity to pressure</del>. <del class="diffchange diffchange-inline">Sometimes people may be unable to wear shoes because </del>the <del class="diffchange diffchange-inline">area is too sensitive</del>.<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://<del class="diffchange diffchange-inline">brandeesimler</del>.<del class="diffchange diffchange-inline">Hatenablog</del>.com/<del class="diffchange diffchange-inline">entry</del>/<del class="diffchange diffchange-inline">2015</del>/<del class="diffchange diffchange-inline">03/18/184003 </del>heel spurs] and plantar fasciitis, it?s important to seek treatment.<br><br>Non Surgical Treatment<br><del class="diffchange diffchange-inline">Most cases of </del>accessory navicular <del class="diffchange diffchange-inline">syndrome </del>may <del class="diffchange diffchange-inline">be treated conservatively </del>with <del class="diffchange diffchange-inline">some sort </del>of <del class="diffchange diffchange-inline">immobilization</del>. This should allow the <del class="diffchange diffchange-inline">fibrous tissue between the two bones </del>to <del class="diffchange diffchange-inline">heal</del>. <del class="diffchange diffchange-inline">If a patient is extremely flat footed (pronated) then I lean more towards an orthotic than a boot as my main goal is </del>to <del class="diffchange diffchange-inline">keep </del>the <del class="diffchange diffchange-inline">patient's foot from flattening out too much </del>and <del class="diffchange diffchange-inline">thus reduce the strain on the two bones</del>. <del class="diffchange diffchange-inline">Supplementation with ice</del>, <del class="diffchange diffchange-inline">oral anti</del>-<del class="diffchange diffchange-inline">inflammatory medication</del>. <del class="diffchange diffchange-inline">If the patient is athletic </del>sometimes <del class="diffchange diffchange-inline">we can keep them active with an orthotic</del>, <del class="diffchange diffchange-inline">but other times they have to give up their sport for </del>a <del class="diffchange diffchange-inline">period of time </del>to <del class="diffchange diffchange-inline">allow the condition </del>to <del class="diffchange diffchange-inline">heal</del>.<br><br><br><br>Surgical Treatment<br><del class="diffchange diffchange-inline">Once the navicular inflammation has lessened it is not necessary to perform surgery unless the foot becomes progressively flatter or continues to be painful. For these children, surgery can completely correct the problem </del>by <del class="diffchange diffchange-inline">removing </del>the accessory navicular bone <del class="diffchange diffchange-inline">and tightening up </del>the posterior tibial tendon <del class="diffchange diffchange-inline">that attaches to </del>the navicular bone<del class="diffchange diffchange-inline">. The strength </del>of this tendon <del class="diffchange diffchange-inline">is integral to the success </del>of <del class="diffchange diffchange-inline">this surgery as well as </del>the <del class="diffchange diffchange-inline">arch </del>of the <del class="diffchange diffchange-inline">foot</del>. <del class="diffchange diffchange-inline">Following surgery the child is able </del>to <del class="diffchange diffchange-inline">begin walking on </del>the <del class="diffchange diffchange-inline">foot (in </del>a <del class="diffchange diffchange-inline">cast) at approximately two weeks</del>. <del class="diffchange diffchange-inline">The cast is worn for an additional four weeks. A small soft ankle support brace is then put into the shoe and worn with activities and exercise for </del>a <del class="diffchange diffchange-inline">further two months</del>.</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>Overview<br><ins class="diffchange diffchange-inline">Accessory navicular syndrome occurs when a type II </ins>accessory navicular <ins class="diffchange diffchange-inline">(</ins>or <ins class="diffchange diffchange-inline">"</ins>os tibiale externum<ins class="diffchange diffchange-inline">") becomes painful due </ins>to <ins class="diffchange diffchange-inline">movement across </ins>the <ins class="diffchange diffchange-inline">pseudojoint between </ins>the <ins class="diffchange diffchange-inline">ossicle </ins>and the navicular <ins class="diffchange diffchange-inline">bone</ins>. <ins class="diffchange diffchange-inline">The </ins>syndrome <ins class="diffchange diffchange-inline">presents on MRI with </ins>bone <ins class="diffchange diffchange-inline">marrow oedema signal (hypointense T1</ins>, <ins class="diffchange diffchange-inline">hyperintense T2/STIR) in </ins>both the accessory <ins class="diffchange diffchange-inline">ossicle and </ins>navicular. <ins class="diffchange diffchange-inline">It </ins>can be <ins class="diffchange diffchange-inline">inferred on musculoskeletal ultrasound if a patient's pain is located at a type II accessory navicular </ins>and the <ins class="diffchange diffchange-inline">patient is tender to transducer pressure</ins>. <ins class="diffchange diffchange-inline">Ultrasound can </ins>also <ins class="diffchange diffchange-inline">be useful to compare </ins>with the <ins class="diffchange diffchange-inline">contralateral side</ins>.<br><br><br><br>Causes<br><ins class="diffchange diffchange-inline">Like all painful conditions</ins>, <ins class="diffchange diffchange-inline">ANS has a root cause</ins>. The <ins class="diffchange diffchange-inline">cause could be </ins>the accessory navicular bone <ins class="diffchange diffchange-inline">itself producing irritation from shoes or too much activity</ins>. <ins class="diffchange diffchange-inline">Often, however, it </ins>is <ins class="diffchange diffchange-inline">related to injury of one of the structures that attach to the </ins>navicular bone. <ins class="diffchange diffchange-inline">Structures that attach to </ins>the <ins class="diffchange diffchange-inline">navicular </ins>bone <ins class="diffchange diffchange-inline">include abductor hallucis muscle, plantar calcaneonavicular ligament (spring ligament) parts of </ins>the <ins class="diffchange diffchange-inline">deltoid ligament, posterior tibial tendon</ins>.<br><br>Symptoms<br><ins class="diffchange diffchange-inline">Adolescence is a common time for the symptoms to first appear. </ins>This is <ins class="diffchange diffchange-inline">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 </ins>accessory navicular syndrome <ins class="diffchange diffchange-inline">include A visible bony prominence on the midfoot </ins>(the <ins class="diffchange diffchange-inline">inner side of the </ins>foot, <ins class="diffchange diffchange-inline">just above the arch) </ins>Redness and swelling <ins class="diffchange diffchange-inline">of the </ins>bony prominence. <ins class="diffchange diffchange-inline">Vague pain or throbbing in </ins>the <ins class="diffchange diffchange-inline">midfoot and arch, usually occurring during or after periods of activity</ins>.<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://<ins class="diffchange diffchange-inline">AmmieBaillie</ins>.<ins class="diffchange diffchange-inline">Bravesites</ins>.com/<ins class="diffchange diffchange-inline">entries</ins>/<ins class="diffchange diffchange-inline">general</ins>/<ins class="diffchange diffchange-inline">Hammer-Toe-Pain-Ball-Foot </ins>heel spurs] and plantar fasciitis, it?s important to seek treatment.<br><br>Non Surgical Treatment<br><ins class="diffchange diffchange-inline">Patients with a painful </ins>accessory navicular may <ins class="diffchange diffchange-inline">benefit </ins>with <ins class="diffchange diffchange-inline">four to six physical therapy treatments. Your therapist may design a series </ins>of <ins class="diffchange diffchange-inline">stretching exercises to try and ease tension on the posterior tibial tendon. A shoe insert, or orthotic, may be used to support the arch and protect the sore area</ins>. This <ins class="diffchange diffchange-inline">approach may allow you to resume normal walking immediately, but you </ins>should <ins class="diffchange diffchange-inline">probably cut back on more vigorous activities for several weeks to </ins>allow the <ins class="diffchange diffchange-inline">inflammation and pain </ins>to <ins class="diffchange diffchange-inline">subside</ins>. <ins class="diffchange diffchange-inline">Treatments directed </ins>to the <ins class="diffchange diffchange-inline">painful area help control pain </ins>and <ins class="diffchange diffchange-inline">swelling</ins>. <ins class="diffchange diffchange-inline">Examples include ultrasound</ins>, <ins class="diffchange diffchange-inline">moist heat, and soft</ins>-<ins class="diffchange diffchange-inline">tissue massage</ins>. <ins class="diffchange diffchange-inline">Therapy sessions </ins>sometimes <ins class="diffchange diffchange-inline">include iontophoresis</ins>, <ins class="diffchange diffchange-inline">which uses </ins>a <ins class="diffchange diffchange-inline">mild electrical current </ins>to <ins class="diffchange diffchange-inline">push anti-inflammatory medicine </ins>to <ins class="diffchange diffchange-inline">the sore area</ins>.<br><br><br><br>Surgical Treatment<br><ins class="diffchange diffchange-inline">The original procedure advocated </ins>by <ins class="diffchange diffchange-inline">Kidner involved shelling out of </ins>the accessory navicular bone <ins class="diffchange diffchange-inline">from within the insertional area of </ins>the posterior tibial tendon <ins class="diffchange diffchange-inline">and rerouting this tendon under </ins>the navicular bone <ins class="diffchange diffchange-inline">in hopes of restoring a normal pull </ins>of this tendon<ins class="diffchange diffchange-inline">. When treating younger children, history has shown us that simply shelling out </ins>of the <ins class="diffchange diffchange-inline">accessory navicular bone from within the tendon and remodeling the tuberosity </ins>of the <ins class="diffchange diffchange-inline">navicular bone can give you satisfactory results</ins>.<ins class="diffchange diffchange-inline"><br>In general, you want </ins>to <ins class="diffchange diffchange-inline">reserve advancement of </ins>the <ins class="diffchange diffchange-inline">posterior tibial tendon for adults or those who have </ins>a <ins class="diffchange diffchange-inline">more significant flatfoot deformity</ins>. <ins class="diffchange diffchange-inline">You may also use this approach after determining that quality custom orthotics are only resulting in </ins>a <ins class="diffchange diffchange-inline">slight decrease of symptoms</ins>.</div></td></tr>
</table>MitchellHeritagehttp://www.rehime.com.ar/bases/paginasdecine/index.php?title=Extra_Bone_In_Foot_Accessory_Navicular&diff=11852&oldid=prevHSRHollis044987 en 22:46 11 jun 20172017-06-11T22:46:35Z<p></p>
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<td colspan='2' style="background-color: white; color:black; text-align: center;">Revisión de 22:46 11 jun 2017</td>
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<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>Overview<br>The <del class="diffchange diffchange-inline">bones of </del>the <del class="diffchange diffchange-inline">foot occasionally develop abnormally in a child and </del>an extra bone <del class="diffchange diffchange-inline">called an accessory navicular is present towards </del>the <del class="diffchange diffchange-inline">inside </del>of the foot<del class="diffchange diffchange-inline">, in front of </del>the <del class="diffchange diffchange-inline">ankle</del>. This bone is <del class="diffchange diffchange-inline">present </del>in approximately 10% of the <del class="diffchange diffchange-inline">general </del>population <del class="diffchange diffchange-inline">but not large enough to cause symptoms in the majority of these individuals</del>. <del class="diffchange diffchange-inline">The extra bone lump present in childhood can be quite uncomfortable because it rubs on shoes. In addition, the feet associated </del>with <del class="diffchange diffchange-inline">the </del>accessory navicular are <del class="diffchange diffchange-inline">invariably flat</del>. <del class="diffchange diffchange-inline">If the child </del>is <del class="diffchange diffchange-inline">active and involved in various athletic activities</del>, <del class="diffchange diffchange-inline">this will aggravate the inflammation of </del>the tendon <del class="diffchange diffchange-inline">that attaches to the accessory </del>navicular<del class="diffchange diffchange-inline">. This tendon </del>is <del class="diffchange diffchange-inline">called </del>the posterior tibial tendon and <del class="diffchange diffchange-inline">is responsible for maintaining </del>the <del class="diffchange diffchange-inline">strength </del>of <del class="diffchange diffchange-inline">the arch of the </del>foot. <del class="diffchange diffchange-inline">The flat-footedness associated </del>with the accessory <del class="diffchange diffchange-inline">navicular usually brings </del>the <del class="diffchange diffchange-inline">child for treatment</del>.<br><br><br><br>Causes<br><del class="diffchange diffchange-inline">This can result from any </del>of the <del class="diffchange diffchange-inline">following. Trauma</del>, <del class="diffchange diffchange-inline">as in a foot or ankle sprain</del>. <del class="diffchange diffchange-inline">Chronic irritation from shoes or other footwear rubbing against </del>the <del class="diffchange diffchange-inline">extra </del>bone. <del class="diffchange diffchange-inline">Excessive activity or overuse</del>. <del class="diffchange diffchange-inline">Many people with </del>accessory navicular <del class="diffchange diffchange-inline">syndrome also have flat feet (fallen arches)</del>. <del class="diffchange diffchange-inline">Having a flat foot puts more strain </del>on the <del class="diffchange diffchange-inline">posterior tibial tendon, which can produce inflammation or irritation of the accessory navicular</del>.<br><br>Symptoms<br><del class="diffchange diffchange-inline">One obvious problem with the </del>accessory navicular <del class="diffchange diffchange-inline">is that it may be large and stick out from the inside of the foot</del>. <del class="diffchange diffchange-inline">This </del>can cause <del class="diffchange diffchange-inline">it to rub against shoes </del>and <del class="diffchange diffchange-inline">so become quite painful</del>. <del class="diffchange diffchange-inline">The fibrous connection between the accessory navicular </del>and <del class="diffchange diffchange-inline">the navicualar</del>, as well<del class="diffchange diffchange-inline">, is easy </del>to <del class="diffchange diffchange-inline">injure, also leading to pain</del>. <del class="diffchange diffchange-inline">This is kind of like a fracture, and such injuries cause the bone </del>to <del class="diffchange diffchange-inline">move around too easily, leading to pain with activity. When </del>the <del class="diffchange diffchange-inline">connection between the bones </del>is <del class="diffchange diffchange-inline">injured in this way, the two bones do not always heal properly, so pain may continue unabated</del>.<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://<del class="diffchange diffchange-inline">Shelliefriedrich</del>.<del class="diffchange diffchange-inline">bravesites</del>.com heel spurs] and plantar fasciitis, it?s important to seek treatment.<br><br>Non Surgical Treatment<br><del class="diffchange diffchange-inline">Fortunately, surgery is not the only answer when it comes to relieving symptoms </del>of accessory navicular syndrome<del class="diffchange diffchange-inline">. The physician </del>may <del class="diffchange diffchange-inline">recommend wearing </del>a <del class="diffchange diffchange-inline">cast or walking boot for </del>a <del class="diffchange diffchange-inline">period of time so </del>the foot <del class="diffchange diffchange-inline">can recover </del>from the <del class="diffchange diffchange-inline">inflammation</del>. <del class="diffchange diffchange-inline">Ice may be used to relieve swelling</del>, <del class="diffchange diffchange-inline">too</del>, <del class="diffchange diffchange-inline">although it should be wrapped </del>to <del class="diffchange diffchange-inline">avoid direct contact with </del>the <del class="diffchange diffchange-inline">skin</del>.<br><br><br><br>Surgical Treatment<br><del class="diffchange diffchange-inline">The above non-surgical options should be enough to treat accessory </del>navicular <del class="diffchange diffchange-inline">syndrome</del>. <del class="diffchange diffchange-inline">If they fail</del>, <del class="diffchange diffchange-inline">a </del>surgery <del class="diffchange diffchange-inline">would be necessary to remove </del>the <del class="diffchange diffchange-inline">extra </del>bone that <del class="diffchange diffchange-inline">has been causing </del>the <del class="diffchange diffchange-inline">problems</del>. The <del class="diffchange diffchange-inline">most common procedure for </del>this <del class="diffchange diffchange-inline">condition </del>is <del class="diffchange diffchange-inline">known </del>as the <del class="diffchange diffchange-inline">Kidner procedure where a small incision is made over </del>the <del class="diffchange diffchange-inline">navicular bone</del>. <del class="diffchange diffchange-inline">The accessory navicular </del>is <del class="diffchange diffchange-inline">identified and dissected free from </del>the <del class="diffchange diffchange-inline">posterior tibial tendon</del>. The <del class="diffchange diffchange-inline">posterior tibial tendon </del>is then <del class="diffchange diffchange-inline">reattached to </del>the <del class="diffchange diffchange-inline">remaining navicular bone</del>.</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>Overview<br>The <ins class="diffchange diffchange-inline">accessory navicular also termed </ins>the <ins class="diffchange diffchange-inline">os navicularum or os tibiale externum - is </ins>an extra bone <ins class="diffchange diffchange-inline">or piece of cartilage on </ins>the <ins class="diffchange diffchange-inline">inner side </ins>of the foot <ins class="diffchange diffchange-inline">above </ins>the <ins class="diffchange diffchange-inline">arch that attaches to the posterior tibial tendon within this area</ins>. This <ins class="diffchange diffchange-inline">extra </ins>bone<ins class="diffchange diffchange-inline">, present at birth, </ins>is <ins class="diffchange diffchange-inline">not part of the normal bone structure and found </ins>in approximately 10% of the population. <ins class="diffchange diffchange-inline">Some people </ins>with <ins class="diffchange diffchange-inline">an </ins>accessory navicular <ins class="diffchange diffchange-inline">may be unaware of the condition if symptoms </ins>are <ins class="diffchange diffchange-inline">never experienced</ins>. <ins class="diffchange diffchange-inline">But accessory navicular syndrome </ins>is <ins class="diffchange diffchange-inline">a painful condition caused  by aggravating the bone</ins>, the <ins class="diffchange diffchange-inline">posterior tibial </ins>tendon <ins class="diffchange diffchange-inline">or both.\Accessory </ins>navicular <ins class="diffchange diffchange-inline">syndrome </ins>is <ins class="diffchange diffchange-inline">an irritation of </ins>the <ins class="diffchange diffchange-inline">accessory navicular and/or </ins>posterior tibial tendon<ins class="diffchange diffchange-inline">. This irritation can be caused by shoe rubbing, trauma, excessive activity, or overuse </ins>and <ins class="diffchange diffchange-inline">can cause problems with </ins>the <ins class="diffchange diffchange-inline">shape and function </ins>of <ins class="diffchange diffchange-inline">your </ins>foot. <ins class="diffchange diffchange-inline">Many people </ins>with <ins class="diffchange diffchange-inline">this disorder also have flat feet which puts more strain on </ins>the <ins class="diffchange diffchange-inline">posterior tibial tendon. Some people are born with an </ins>accessory <ins class="diffchange diffchange-inline">Navicular because during development, </ins>the <ins class="diffchange diffchange-inline">bones of the feet sometimes develop abnormally causing the extra bone to form on the inside of the foot</ins>.<br><br><br><br>Causes<br><ins class="diffchange diffchange-inline">Most </ins>of the <ins class="diffchange diffchange-inline">time</ins>, <ins class="diffchange diffchange-inline">this condition is asymptomatic and people may live their whole lives unaware that they even have this extra bone</ins>. <ins class="diffchange diffchange-inline">The main reason </ins>the <ins class="diffchange diffchange-inline">accessory navicular </ins>bone <ins class="diffchange diffchange-inline">becomes problematic is when pain occurs</ins>. <ins class="diffchange diffchange-inline">There is no need for intervention if there is no pain</ins>. <ins class="diffchange diffchange-inline">The </ins>accessory navicular <ins class="diffchange diffchange-inline">bone is easily felt in the medial arch because it forms a bony prominence there</ins>. <ins class="diffchange diffchange-inline">Pain may occur if the accessory bone is overly large causing this bump </ins>on the <ins class="diffchange diffchange-inline">instep to rub against footwear</ins>.<br><br>Symptoms<br><ins class="diffchange diffchange-inline">This painful condition is called </ins>accessory navicular <ins class="diffchange diffchange-inline">syndrome</ins>. <ins class="diffchange diffchange-inline">Accessory navicular syndrome (ANS) </ins>can cause <ins class="diffchange diffchange-inline">significant pain in the mid-foot </ins>and <ins class="diffchange diffchange-inline">arch, especially with activity</ins>. <ins class="diffchange diffchange-inline">Redness </ins>and <ins class="diffchange diffchange-inline">swelling may develop over this bony prominence</ins>, as well <ins class="diffchange diffchange-inline">as extreme sensitivity </ins>to <ins class="diffchange diffchange-inline">pressure</ins>. <ins class="diffchange diffchange-inline">Sometimes people may be unable </ins>to <ins class="diffchange diffchange-inline">wear shoes because </ins>the <ins class="diffchange diffchange-inline">area </ins>is <ins class="diffchange diffchange-inline">too sensitive</ins>.<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://<ins class="diffchange diffchange-inline">brandeesimler</ins>.<ins class="diffchange diffchange-inline">Hatenablog</ins>.com<ins class="diffchange diffchange-inline">/entry/2015/03/18/184003 </ins>heel spurs] and plantar fasciitis, it?s important to seek treatment.<br><br>Non Surgical Treatment<br><ins class="diffchange diffchange-inline">Most cases </ins>of accessory navicular syndrome may <ins class="diffchange diffchange-inline">be treated conservatively with some sort of immobilization. This should allow the fibrous tissue between the two bones to heal. If </ins>a <ins class="diffchange diffchange-inline">patient is extremely flat footed (pronated) then I lean more towards an orthotic than </ins>a <ins class="diffchange diffchange-inline">boot as my main goal is to keep </ins>the <ins class="diffchange diffchange-inline">patient's </ins>foot from <ins class="diffchange diffchange-inline">flattening out too much and thus reduce </ins>the <ins class="diffchange diffchange-inline">strain on the two bones</ins>. <ins class="diffchange diffchange-inline">Supplementation with ice</ins>, <ins class="diffchange diffchange-inline">oral anti-inflammatory medication. If the patient is athletic sometimes we can keep them active with an orthotic</ins>, <ins class="diffchange diffchange-inline">but other times they have </ins>to <ins class="diffchange diffchange-inline">give up their sport for a period of time to allow </ins>the <ins class="diffchange diffchange-inline">condition to heal</ins>.<br><br><br><br>Surgical Treatment<br><ins class="diffchange diffchange-inline">Once the </ins>navicular <ins class="diffchange diffchange-inline">inflammation has lessened it is not necessary to perform surgery unless the foot becomes progressively flatter or continues to be painful</ins>. <ins class="diffchange diffchange-inline">For these children</ins>, surgery <ins class="diffchange diffchange-inline">can completely correct </ins>the <ins class="diffchange diffchange-inline">problem by removing the accessory navicular </ins>bone <ins class="diffchange diffchange-inline">and tightening up the posterior tibial tendon </ins>that <ins class="diffchange diffchange-inline">attaches to </ins>the <ins class="diffchange diffchange-inline">navicular bone</ins>. The <ins class="diffchange diffchange-inline">strength of </ins>this <ins class="diffchange diffchange-inline">tendon </ins>is <ins class="diffchange diffchange-inline">integral to the success of this surgery as well </ins>as the <ins class="diffchange diffchange-inline">arch of </ins>the <ins class="diffchange diffchange-inline">foot</ins>. <ins class="diffchange diffchange-inline">Following surgery the child </ins>is <ins class="diffchange diffchange-inline">able to begin walking on </ins>the <ins class="diffchange diffchange-inline">foot (in a cast) at approximately two weeks</ins>. The <ins class="diffchange diffchange-inline">cast is worn for an additional four weeks. A small soft ankle support brace </ins>is then <ins class="diffchange diffchange-inline">put into </ins>the <ins class="diffchange diffchange-inline">shoe and worn with activities and exercise for a further two months</ins>.</div></td></tr>
</table>HSRHollis044987http://www.rehime.com.ar/bases/paginasdecine/index.php?title=Extra_Bone_In_Foot_Accessory_Navicular&diff=11664&oldid=prevCynthiaStopford en 22:03 11 jun 20172017-06-11T22:03:08Z<p></p>
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<td colspan='2' style="background-color: white; color:black; text-align: center;">Revisión de 22:03 11 jun 2017</td>
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<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>Overview<br><del class="diffchange diffchange-inline">An accessory navicular is defined as </del>an extra bone <del class="diffchange diffchange-inline">in </del>the foot, <del class="diffchange diffchange-inline">and oftentimes it causes moderate </del>to <del class="diffchange diffchange-inline">severe discomfort</del>. <del class="diffchange diffchange-inline"> Depending </del>on the <del class="diffchange diffchange-inline">severity</del>, <del class="diffchange diffchange-inline">your doctor may recommend a non-surgical treatment </del>to <del class="diffchange diffchange-inline">alleviate </del>the <del class="diffchange diffchange-inline">pain, or surgery if </del>treatment <del class="diffchange diffchange-inline">doesn?t decrease symptoms</del>.<br><br><br><br>Causes<br>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.<br><br>Symptoms<br><del class="diffchange diffchange-inline">Most people born </del>with <del class="diffchange diffchange-inline">this bone begin to experience </del>the <del class="diffchange diffchange-inline">symptoms (if at all any) in adolescence. Some </del>may <del class="diffchange diffchange-inline">not develop any symptoms until adulthood</del>. The <del class="diffchange diffchange-inline">symptoms are a visible abnormal protrusion in </del>the <del class="diffchange diffchange-inline">mid-foot, swelling </del>and <del class="diffchange diffchange-inline">redness </del>of the <del class="diffchange diffchange-inline">protrusion</del>, pain in the <del class="diffchange diffchange-inline">mid-foot after performing an activity</del>.<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://<del class="diffchange diffchange-inline">solangeLesage</del>.<del class="diffchange diffchange-inline">jimdo</del>.com<del class="diffchange diffchange-inline">/2015/06/23/contracted-toe-causes </del>heel spurs] and plantar fasciitis, it?s important to seek treatment.<br><br>Non Surgical Treatment<br><del class="diffchange diffchange-inline">Aside from </del>surgery<del class="diffchange diffchange-inline">, there are a few options for handling an </del>accessory navicular <del class="diffchange diffchange-inline">bone that has become symptomatic</del>. <del class="diffchange diffchange-inline">This includes immobilization, icing, medicating, physical therapy, and orthotic devices. Immobilizing involves placing the foot and ankle in </del>a cast or <del class="diffchange diffchange-inline">removable </del>walking boot<del class="diffchange diffchange-inline">. This alleviates stressors on </del>the foot <del class="diffchange diffchange-inline">and </del>can <del class="diffchange diffchange-inline">decrease </del>inflammation. <del class="diffchange diffchange-inline">Icing will help reduce swelling and inflammation. Medication involves usage of nonsteroidal anti-inflammatory drugs, or steroids (taken orally or injected) to decrease inflammation. Physical therapy can </del>be <del class="diffchange diffchange-inline">prescribed in order </del>to <del class="diffchange diffchange-inline">strengthen the muscles and help decrease inflammation. Physical therapy can also help prevent the symptoms from returning. Orthotic devices (arch support devices that fit in a shoe) can help prevent future symptoms. Occasionally</del>, <del class="diffchange diffchange-inline">the orthotic device will dig into the edge of the accessory navicular and cause discomfort. For this reason</del>, <del class="diffchange diffchange-inline">the orthotic devices made for the patient </del>should be <del class="diffchange diffchange-inline">carefully constructed</del>.<br><br><br><br>Surgical Treatment<br><del class="diffchange diffchange-inline">If conservative care does not alleviate the problem then </del>surgical <del class="diffchange diffchange-inline">intervention </del>should be <del class="diffchange diffchange-inline">considered</del>. The most common procedure for this condition is known as the Kidner procedure where a small incision is made over the navicular bone. The accessory navicular is identified and dissected free from the posterior tibial tendon. The posterior tibial tendon is then reattached to the remaining navicular bone.</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>Overview<br><ins class="diffchange diffchange-inline">The bones of the foot occasionally develop abnormally in a child and </ins>an extra bone <ins class="diffchange diffchange-inline">called an accessory navicular is present towards the inside of </ins>the foot, <ins class="diffchange diffchange-inline">in front of the ankle. This bone is present in approximately 10% of the general population but not large enough </ins>to <ins class="diffchange diffchange-inline">cause symptoms in the majority of these individuals</ins>. <ins class="diffchange diffchange-inline">The extra bone lump present in childhood can be quite uncomfortable because it rubs </ins>on <ins class="diffchange diffchange-inline">shoes. In addition, </ins>the <ins class="diffchange diffchange-inline">feet associated with the accessory navicular are invariably flat. If the child is active and involved in various athletic activities</ins>, <ins class="diffchange diffchange-inline">this will aggravate the inflammation of the tendon that attaches </ins>to the <ins class="diffchange diffchange-inline">accessory navicular. This tendon is called the posterior tibial tendon and is responsible for maintaining the strength of the arch of the foot. The flat-footedness associated with the accessory navicular usually brings the child for </ins>treatment.<br><br><br><br>Causes<br>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.<br><br>Symptoms<br><ins class="diffchange diffchange-inline">One obvious problem </ins>with the <ins class="diffchange diffchange-inline">accessory navicular is that it </ins>may <ins class="diffchange diffchange-inline">be large and stick out from the inside of the foot. This can cause it to rub against shoes and so become quite painful</ins>. The <ins class="diffchange diffchange-inline">fibrous connection between </ins>the <ins class="diffchange diffchange-inline">accessory navicular </ins>and <ins class="diffchange diffchange-inline">the navicualar, as well, is easy to injure, also leading to pain. This is kind </ins>of <ins class="diffchange diffchange-inline">like a fracture, and such injuries cause </ins>the <ins class="diffchange diffchange-inline">bone to move around too easily</ins>, <ins class="diffchange diffchange-inline">leading to </ins>pain <ins class="diffchange diffchange-inline">with activity. When the connection between the bones is injured </ins>in <ins class="diffchange diffchange-inline">this way, </ins>the <ins class="diffchange diffchange-inline">two bones do not always heal properly, so pain may continue unabated</ins>.<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://<ins class="diffchange diffchange-inline">Shelliefriedrich</ins>.<ins class="diffchange diffchange-inline">bravesites</ins>.com heel spurs] and plantar fasciitis, it?s important to seek treatment.<br><br>Non Surgical Treatment<br><ins class="diffchange diffchange-inline">Fortunately, </ins>surgery <ins class="diffchange diffchange-inline">is not the only answer when it comes to relieving symptoms of </ins>accessory navicular <ins class="diffchange diffchange-inline">syndrome</ins>. <ins class="diffchange diffchange-inline">The physician may recommend wearing </ins>a cast or walking boot <ins class="diffchange diffchange-inline">for a period of time so </ins>the foot can <ins class="diffchange diffchange-inline">recover from the </ins>inflammation. <ins class="diffchange diffchange-inline">Ice may </ins>be <ins class="diffchange diffchange-inline">used </ins>to <ins class="diffchange diffchange-inline">relieve swelling</ins>, <ins class="diffchange diffchange-inline">too</ins>, <ins class="diffchange diffchange-inline">although it </ins>should be <ins class="diffchange diffchange-inline">wrapped to avoid direct contact with the skin</ins>.<br><br><br><br>Surgical Treatment<br><ins class="diffchange diffchange-inline">The above non-</ins>surgical <ins class="diffchange diffchange-inline">options </ins>should be <ins class="diffchange diffchange-inline">enough to treat accessory navicular syndrome. If they fail, a surgery would be necessary to remove the extra bone that has been causing the problems</ins>. The most common procedure for this condition is known as the Kidner procedure where a small incision is made over the navicular bone. The accessory navicular is identified and dissected free from the posterior tibial tendon. The posterior tibial tendon is then reattached to the remaining navicular bone.</div></td></tr>
</table>CynthiaStopfordhttp://www.rehime.com.ar/bases/paginasdecine/index.php?title=Extra_Bone_In_Foot_Accessory_Navicular&diff=11125&oldid=prevBillyCardwell3 en 19:51 11 jun 20172017-06-11T19:51:50Z<p></p>
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<td colspan='2' style="background-color: white; color:black; text-align: center;">← Revisión anterior</td>
<td colspan='2' style="background-color: white; color:black; text-align: center;">Revisión de 19:51 11 jun 2017</td>
</tr><tr><td colspan="2" class="diff-lineno">Línea 1:</td>
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<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>Overview<br><del class="diffchange diffchange-inline">When there is injury to the muscle, fibrous tissue, or soft tissue of the navicular and the </del>accessory navicular <del class="diffchange diffchange-inline">bones, symptoms will arise. This injury allows excessive movement between the bones. Fibrous tissue, ligaments and tendons have poor blood supply and are prone to poor healing. Often, this </del>extra <del class="diffchange diffchange-inline">navicular </del>bone <del class="diffchange diffchange-inline">lies near or attaches to </del>the <del class="diffchange diffchange-inline">posterior tibial tendon. (See figure.) When the posterior tibial muscle contracts with movements such as </del>foot <del class="diffchange diffchange-inline">inversion or plantar flexion</del>, <del class="diffchange diffchange-inline">the posterior tendon moves </del>and <del class="diffchange diffchange-inline">the accessory navicular bone moves. This can cause </del>severe <del class="diffchange diffchange-inline">pain in those with Accessory Navicular Syndrome</del>. <del class="diffchange diffchange-inline">It can become disabling to patients because </del>the <del class="diffchange diffchange-inline">posterior tibial tendon attached </del>to the <del class="diffchange diffchange-inline">navicular bone is responsible for supporting the medial arch during standing</del>, <del class="diffchange diffchange-inline">walking and running</del>. <del class="diffchange diffchange-inline">Activities which most of us do daily!</del><br><br><br><br>Causes<br><del class="diffchange diffchange-inline">It is commonly believed that the posterior tibial tendon loses its vector </del>of <del class="diffchange diffchange-inline">pull to heighten </del>the <del class="diffchange diffchange-inline">arch</del>. <del class="diffchange diffchange-inline">As the posterior muscle contracts</del>, the <del class="diffchange diffchange-inline">tendon is no longer pulling straight up on the navicular but must course around the prominence of </del>bone <del class="diffchange diffchange-inline">and first pull medially before pulling upward</del>. <del class="diffchange diffchange-inline">In addition, the enlarged bones may irritate and damage the insertional area of </del>the posterior tibial tendon, <del class="diffchange diffchange-inline">making it less functional. Therefore, the presence </del>of the accessory navicular <del class="diffchange diffchange-inline">bone does contribute to posterior tibial dysfunction</del>.<br><br>Symptoms<br><del class="diffchange diffchange-inline">What precipitates </del>the <del class="diffchange diffchange-inline">pain? It will usually be caused by rubbing of the skate or other footwear against the prominence</del>. <del class="diffchange diffchange-inline">You?ll commonly see blisters or a red irritated area</del>. <del class="diffchange diffchange-inline">Other </del>symptoms <del class="diffchange diffchange-inline">to look for</del>, <del class="diffchange diffchange-inline">especially when you?re treating an older child or adult, include an area of pain along the posterior tibial tendon of the arch </del>and <del class="diffchange diffchange-inline">fatigue </del>of the <del class="diffchange diffchange-inline">legs. Typically</del>, <del class="diffchange diffchange-inline">these patients are not able to participate </del>in <del class="diffchange diffchange-inline">sports for a lengthy period of time or you?ll hear them complain of pain and/or soreness </del>after <del class="diffchange diffchange-inline">extended activities. Most individuals with a prominent navicular area will have tried accommodating this area with a doughnut pad or adjustments to their skate</del>.<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://<del class="diffchange diffchange-inline">cory9franklin81</del>.<del class="diffchange diffchange-inline">Jimdo</del>.com/2015/06/<del class="diffchange diffchange-inline">28</del>/<del class="diffchange diffchange-inline">hammer</del>-toe-<del class="diffchange diffchange-inline">deformity </del>heel spurs] and plantar fasciitis, it?s important to seek treatment.<br><br>Non Surgical Treatment<br><del class="diffchange diffchange-inline">Although operative treatment</del>, <del class="diffchange diffchange-inline">and removal of the </del>accessory navicular <del class="diffchange diffchange-inline">is possible</del>, <del class="diffchange diffchange-inline">this is not usually indicated at first. Conservative nonoperative treatment is best</del>, <del class="diffchange diffchange-inline">the course depending on the severity of the symptoms</del>. <del class="diffchange diffchange-inline">When </del>the <del class="diffchange diffchange-inline">pain is very severe, which could indicate </del>a <del class="diffchange diffchange-inline">fracture, a period of immobilization might be required</del>. This <del class="diffchange diffchange-inline">is done by waring a fracture boot, or a cast, which </del>can help <del class="diffchange diffchange-inline">the ossicle stay stable</del>, <del class="diffchange diffchange-inline">aiding in healing. Immobilization usually lasts between 4 </del>to <del class="diffchange diffchange-inline">6 weeks</del>. <del class="diffchange diffchange-inline">Afterwards, physical </del>therapy <del class="diffchange diffchange-inline">exercise, or any appropriate home course, should </del>be <del class="diffchange diffchange-inline">used </del>to <del class="diffchange diffchange-inline">help </del>strengthen the <del class="diffchange diffchange-inline">ankle </del>and <del class="diffchange diffchange-inline">return </del>the <del class="diffchange diffchange-inline">ankle and foot to full range of motion</del>, and <del class="diffchange diffchange-inline">have no pain on movement</del>. <del class="diffchange diffchange-inline">Sometimes crutches are used when weight bearing is too painful</del>, <del class="diffchange diffchange-inline">but it is best to try to bear weight when possible</del>.<br><br><br><br>Surgical Treatment<br>The <del class="diffchange diffchange-inline">original </del>procedure <del class="diffchange diffchange-inline">advocated by </del>Kidner <del class="diffchange diffchange-inline">involved shelling out of </del>the accessory navicular <del class="diffchange diffchange-inline">bone </del>from <del class="diffchange diffchange-inline">within the insertional area of </del>the posterior tibial <del class="diffchange diffchange-inline">tendon and rerouting this tendon under the navicular bone in hopes of restoring a normal pull of this </del>tendon. <del class="diffchange diffchange-inline">When treating younger children, history has shown us that simply shelling out of the accessory navicular bone from within the </del>tendon <del class="diffchange diffchange-inline">and remodeling the tuberosity of </del>the navicular bone <del class="diffchange diffchange-inline">can give you satisfactory results.<br>In general, you want to reserve advancement of the posterior tibial tendon for adults or those who have a more significant flatfoot deformity. You may also use this approach after determining that quality custom orthotics are only resulting in a slight decrease of symptoms</del>.</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>Overview<br><ins class="diffchange diffchange-inline">An </ins>accessory navicular <ins class="diffchange diffchange-inline">is defined as an </ins>extra bone <ins class="diffchange diffchange-inline">in </ins>the foot, and <ins class="diffchange diffchange-inline">oftentimes it causes moderate to </ins>severe <ins class="diffchange diffchange-inline">discomfort</ins>. <ins class="diffchange diffchange-inline"> Depending on </ins>the <ins class="diffchange diffchange-inline">severity, your doctor may recommend a non-surgical treatment </ins>to <ins class="diffchange diffchange-inline">alleviate </ins>the <ins class="diffchange diffchange-inline">pain</ins>, <ins class="diffchange diffchange-inline">or surgery if treatment doesn?t decrease symptoms</ins>.<br><br><br><br>Causes<br><ins class="diffchange diffchange-inline">This can result from any </ins>of the <ins class="diffchange diffchange-inline">following</ins>. <ins class="diffchange diffchange-inline">Trauma</ins>, <ins class="diffchange diffchange-inline">as in a foot or ankle sprain. Chronic irritation from shoes or other footwear rubbing against </ins>the <ins class="diffchange diffchange-inline">extra </ins>bone. <ins class="diffchange diffchange-inline">Excessive activity or overuse. Many people with accessory navicular syndrome also have flat feet (fallen arches). Having a flat foot puts more strain on </ins>the posterior tibial tendon, <ins class="diffchange diffchange-inline">which can produce inflammation or irritation </ins>of the accessory navicular.<br><br>Symptoms<br><ins class="diffchange diffchange-inline">Most people born with this bone begin to experience </ins>the <ins class="diffchange diffchange-inline">symptoms (if at all any) in adolescence</ins>. <ins class="diffchange diffchange-inline">Some may not develop any symptoms until adulthood</ins>. <ins class="diffchange diffchange-inline">The </ins>symptoms <ins class="diffchange diffchange-inline">are a visible abnormal protrusion in the mid-foot</ins>, <ins class="diffchange diffchange-inline">swelling </ins>and <ins class="diffchange diffchange-inline">redness </ins>of the <ins class="diffchange diffchange-inline">protrusion</ins>, <ins class="diffchange diffchange-inline">pain </ins>in <ins class="diffchange diffchange-inline">the mid-foot </ins>after <ins class="diffchange diffchange-inline">performing an activity</ins>.<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://<ins class="diffchange diffchange-inline">solangeLesage</ins>.<ins class="diffchange diffchange-inline">jimdo</ins>.com/2015/06/<ins class="diffchange diffchange-inline">23</ins>/<ins class="diffchange diffchange-inline">contracted</ins>-toe-<ins class="diffchange diffchange-inline">causes </ins>heel spurs] and plantar fasciitis, it?s important to seek treatment.<br><br>Non Surgical Treatment<br><ins class="diffchange diffchange-inline">Aside from surgery</ins>, <ins class="diffchange diffchange-inline">there are a few options for handling an </ins>accessory navicular <ins class="diffchange diffchange-inline">bone that has become symptomatic. This includes immobilization</ins>, <ins class="diffchange diffchange-inline">icing, medicating</ins>, <ins class="diffchange diffchange-inline">physical therapy, and orthotic devices</ins>. <ins class="diffchange diffchange-inline">Immobilizing involves placing </ins>the <ins class="diffchange diffchange-inline">foot and ankle in </ins>a <ins class="diffchange diffchange-inline">cast or removable walking boot</ins>. This <ins class="diffchange diffchange-inline">alleviates stressors on the foot and </ins>can <ins class="diffchange diffchange-inline">decrease inflammation. Icing will </ins>help <ins class="diffchange diffchange-inline">reduce swelling and inflammation. Medication involves usage of nonsteroidal anti-inflammatory drugs</ins>, <ins class="diffchange diffchange-inline">or steroids (taken orally or injected) </ins>to <ins class="diffchange diffchange-inline">decrease inflammation</ins>. <ins class="diffchange diffchange-inline">Physical </ins>therapy <ins class="diffchange diffchange-inline">can </ins>be <ins class="diffchange diffchange-inline">prescribed in order </ins>to strengthen the <ins class="diffchange diffchange-inline">muscles </ins>and <ins class="diffchange diffchange-inline">help decrease inflammation. Physical therapy can also help prevent </ins>the <ins class="diffchange diffchange-inline">symptoms from returning. Orthotic devices (arch support devices that fit in a shoe) can help prevent future symptoms. Occasionally</ins>, <ins class="diffchange diffchange-inline">the orthotic device will dig into the edge of the accessory navicular </ins>and <ins class="diffchange diffchange-inline">cause discomfort</ins>. <ins class="diffchange diffchange-inline">For this reason</ins>, <ins class="diffchange diffchange-inline">the orthotic devices made for the patient should be carefully constructed</ins>.<br><br><br><br>Surgical Treatment<br><ins class="diffchange diffchange-inline">If conservative care does not alleviate the problem then surgical intervention should be considered. </ins>The <ins class="diffchange diffchange-inline">most common </ins>procedure <ins class="diffchange diffchange-inline">for this condition is known as the </ins>Kidner <ins class="diffchange diffchange-inline">procedure where a small incision is made over </ins>the <ins class="diffchange diffchange-inline">navicular bone. The </ins>accessory navicular <ins class="diffchange diffchange-inline">is identified and dissected free </ins>from the posterior tibial tendon. <ins class="diffchange diffchange-inline">The posterior tibial </ins>tendon <ins class="diffchange diffchange-inline">is then reattached to </ins>the <ins class="diffchange diffchange-inline">remaining </ins>navicular bone.</div></td></tr>
</table>BillyCardwell3http://www.rehime.com.ar/bases/paginasdecine/index.php?title=Extra_Bone_In_Foot_Accessory_Navicular&diff=11014&oldid=prevMadonna48Z en 19:22 11 jun 20172017-06-11T19:22:36Z<p></p>
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<td colspan='2' style="background-color: white; color:black; text-align: center;">Revisión de 19:22 11 jun 2017</td>
</tr><tr><td colspan="2" class="diff-lineno">Línea 1:</td>
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<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>Overview<br><del class="diffchange diffchange-inline">An accessory navicular bone </del>is <del class="diffchange diffchange-inline">an accessory bone of </del>the <del class="diffchange diffchange-inline">foot that occasionally develops abnormally in front </del>of the <del class="diffchange diffchange-inline">ankle towards </del>the <del class="diffchange diffchange-inline">inside of the foot</del>. This <del class="diffchange diffchange-inline">bone may be present in approximately 2-14% of </del>the <del class="diffchange diffchange-inline">general population </del>and <del class="diffchange diffchange-inline">is usually asymptomatic</del>. When <del class="diffchange diffchange-inline">it is symptomatic</del>, <del class="diffchange diffchange-inline">surgery may be necessary</del>. <del class="diffchange diffchange-inline">Surgery </del>can <del class="diffchange diffchange-inline">be performed at any age </del>because <del class="diffchange diffchange-inline">it does not alter any other bones</del>.<br><br><br><br>Causes<br><del class="diffchange diffchange-inline">People who have an accessory navicular often are unaware </del>of the <del class="diffchange diffchange-inline">condition if it causes no problems</del>. <del class="diffchange diffchange-inline">However</del>, <del class="diffchange diffchange-inline">some people with this extra bone develop a painful condition known as accessory </del>navicular <del class="diffchange diffchange-inline">syndrome when </del>the bone and<del class="diffchange diffchange-inline">/or posterior tibial tendon are aggravated</del>. <del class="diffchange diffchange-inline">This can result from any </del>of the <del class="diffchange diffchange-inline">following. Trauma</del>, <del class="diffchange diffchange-inline">as in a foot or ankle sprain</del>. <del class="diffchange diffchange-inline">Chronic irritation from shoes or other footwear rubbing against </del>the <del class="diffchange diffchange-inline">extra </del>bone<del class="diffchange diffchange-inline">. Excessive activity or overuse</del>.<br><br>Symptoms<br><del class="diffchange diffchange-inline">The symptoms </del>of <del class="diffchange diffchange-inline">accessory navicular syndrome </del>commonly <del class="diffchange diffchange-inline">arise during adolescence</del>, when <del class="diffchange diffchange-inline">bones are maturing and cartilage fuses into bone. In other instances</del>, <del class="diffchange diffchange-inline">symptoms do not appAccessory Navicularear until adulthood. The signs and symptoms </del>include <del class="diffchange diffchange-inline">a visible bony prominence on </del>the <del class="diffchange diffchange-inline">midfoot the inner side </del>of <del class="diffchange diffchange-inline">the foot above </del>the arch<del class="diffchange diffchange-inline">. Redness or swelling </del>of the <del class="diffchange diffchange-inline">bony prominence</del>. <del class="diffchange diffchange-inline">Indistinct pain or throbbing </del>in <del class="diffchange diffchange-inline">the midfoot </del>and <del class="diffchange diffchange-inline">arch during </del>or after <del class="diffchange diffchange-inline">physical activity</del>.<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://<del class="diffchange diffchange-inline">Kristiecapria</del>.<del class="diffchange diffchange-inline">soup</del>.<del class="diffchange diffchange-inline">io</del>/<del class="diffchange diffchange-inline">post</del>/<del class="diffchange diffchange-inline">594645707</del>/<del class="diffchange diffchange-inline">Hammer</del>-<del class="diffchange diffchange-inline">Toes </del>heel spurs] and plantar fasciitis, it?s important to seek treatment.<br><br>Non Surgical Treatment<br><del class="diffchange diffchange-inline">The </del>treatment <del class="diffchange diffchange-inline">for a symptomatic </del>accessory navicular <del class="diffchange diffchange-inline">can be divided into nonsurgical treatment and surgical treatment</del>. <del class="diffchange diffchange-inline">In </del>the <del class="diffchange diffchange-inline">vast majority </del>of <del class="diffchange diffchange-inline">cases</del>, <del class="diffchange diffchange-inline">treatment usually begins with nonsurgical measures such as orthotics</del>, <del class="diffchange diffchange-inline">strappings </del>or <del class="diffchange diffchange-inline">bracing</del>. <del class="diffchange diffchange-inline">Surgery </del>usually <del class="diffchange diffchange-inline">is only considered when all nonsurgical measures have failed </del>to <del class="diffchange diffchange-inline">control your problem </del>and the pain <del class="diffchange diffchange-inline">becomes intolerable</del>.<br><br><br><br>Surgical Treatment<br><del class="diffchange diffchange-inline">Surgery may be an option if non-surgical treatment does not decrease the symptoms </del>of accessory navicular <del class="diffchange diffchange-inline">syndrome. Since this </del>bone <del class="diffchange diffchange-inline">is not needed for </del>the <del class="diffchange diffchange-inline">foot to function normally</del>, <del class="diffchange diffchange-inline">Your surgeon may remove </del>the accessory navicular<del class="diffchange diffchange-inline">, reshape </del>the <del class="diffchange diffchange-inline">area, </del>and <del class="diffchange diffchange-inline">repair </del>the posterior tibial tendon for <del class="diffchange diffchange-inline">improved function</del>.</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>Overview<br><ins class="diffchange diffchange-inline">When there </ins>is <ins class="diffchange diffchange-inline">injury to </ins>the <ins class="diffchange diffchange-inline">muscle, fibrous tissue, or soft tissue </ins>of the <ins class="diffchange diffchange-inline">navicular and </ins>the <ins class="diffchange diffchange-inline">accessory navicular bones, symptoms will arise</ins>. This <ins class="diffchange diffchange-inline">injury allows excessive movement between </ins>the <ins class="diffchange diffchange-inline">bones. Fibrous tissue, ligaments </ins>and <ins class="diffchange diffchange-inline">tendons have poor blood supply and are prone to poor healing</ins>. <ins class="diffchange diffchange-inline">Often, this extra navicular bone lies near or attaches to the posterior tibial tendon. (See figure.) </ins>When <ins class="diffchange diffchange-inline">the posterior tibial muscle contracts with movements such as foot inversion or plantar flexion</ins>, <ins class="diffchange diffchange-inline">the posterior tendon moves and the accessory navicular bone moves</ins>. <ins class="diffchange diffchange-inline">This </ins>can <ins class="diffchange diffchange-inline">cause severe pain in those with Accessory Navicular Syndrome. It can become disabling to patients </ins>because <ins class="diffchange diffchange-inline">the posterior tibial tendon attached to the navicular bone is responsible for supporting the medial arch during standing, walking and running</ins>. <ins class="diffchange diffchange-inline">Activities which most of us do daily!</ins><br><br><br><br>Causes<br><ins class="diffchange diffchange-inline">It is commonly believed that the posterior tibial tendon loses its vector </ins>of <ins class="diffchange diffchange-inline">pull to heighten </ins>the <ins class="diffchange diffchange-inline">arch</ins>. <ins class="diffchange diffchange-inline">As the posterior muscle contracts</ins>, <ins class="diffchange diffchange-inline">the tendon is no longer pulling straight up on the </ins>navicular <ins class="diffchange diffchange-inline">but must course around </ins>the <ins class="diffchange diffchange-inline">prominence of </ins>bone and <ins class="diffchange diffchange-inline">first pull medially before pulling upward</ins>. <ins class="diffchange diffchange-inline">In addition, the enlarged bones may irritate and damage the insertional area </ins>of the <ins class="diffchange diffchange-inline">posterior tibial tendon</ins>, <ins class="diffchange diffchange-inline">making it less functional</ins>. <ins class="diffchange diffchange-inline">Therefore, </ins>the <ins class="diffchange diffchange-inline">presence of the accessory navicular </ins>bone <ins class="diffchange diffchange-inline">does contribute to posterior tibial dysfunction</ins>.<br><br>Symptoms<br><ins class="diffchange diffchange-inline">What precipitates the pain? It will usually be caused by rubbing </ins>of <ins class="diffchange diffchange-inline">the skate or other footwear against the prominence. You?ll </ins>commonly <ins class="diffchange diffchange-inline">see blisters or a red irritated area. Other symptoms to look for</ins>, <ins class="diffchange diffchange-inline">especially </ins>when <ins class="diffchange diffchange-inline">you?re treating an older child or adult</ins>, include <ins class="diffchange diffchange-inline">an area of pain along </ins>the <ins class="diffchange diffchange-inline">posterior tibial tendon </ins>of the arch <ins class="diffchange diffchange-inline">and fatigue </ins>of the <ins class="diffchange diffchange-inline">legs</ins>. <ins class="diffchange diffchange-inline">Typically, these patients are not able to participate </ins>in <ins class="diffchange diffchange-inline">sports for a lengthy period of time or you?ll hear them complain of pain </ins>and<ins class="diffchange diffchange-inline">/</ins>or <ins class="diffchange diffchange-inline">soreness </ins>after <ins class="diffchange diffchange-inline">extended activities. Most individuals with a prominent navicular area will have tried accommodating this area with a doughnut pad or adjustments to their skate</ins>.<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://<ins class="diffchange diffchange-inline">cory9franklin81</ins>.<ins class="diffchange diffchange-inline">Jimdo</ins>.<ins class="diffchange diffchange-inline">com</ins>/<ins class="diffchange diffchange-inline">2015</ins>/<ins class="diffchange diffchange-inline">06</ins>/<ins class="diffchange diffchange-inline">28/hammer-toe</ins>-<ins class="diffchange diffchange-inline">deformity </ins>heel spurs] and plantar fasciitis, it?s important to seek treatment.<br><br>Non Surgical Treatment<br><ins class="diffchange diffchange-inline">Although operative </ins>treatment<ins class="diffchange diffchange-inline">, and removal of the </ins>accessory navicular <ins class="diffchange diffchange-inline">is possible, this is not usually indicated at first</ins>. <ins class="diffchange diffchange-inline">Conservative nonoperative treatment is best, </ins>the <ins class="diffchange diffchange-inline">course depending on the severity </ins>of <ins class="diffchange diffchange-inline">the symptoms. When the pain is very severe</ins>, <ins class="diffchange diffchange-inline">which could indicate a fracture, a period of immobilization might be required. This is done by waring a fracture boot</ins>, or <ins class="diffchange diffchange-inline">a cast, which can help the ossicle stay stable, aiding in healing</ins>. <ins class="diffchange diffchange-inline">Immobilization </ins>usually <ins class="diffchange diffchange-inline">lasts between 4 </ins>to <ins class="diffchange diffchange-inline">6 weeks. Afterwards, physical therapy exercise, or any appropriate home course, should be used to help strengthen the ankle </ins>and <ins class="diffchange diffchange-inline">return </ins>the <ins class="diffchange diffchange-inline">ankle and foot to full range of motion, and have no </ins>pain <ins class="diffchange diffchange-inline">on movement. Sometimes crutches are used when weight bearing is too painful, but it is best to try to bear weight when possible</ins>.<br><br><br><br>Surgical Treatment<br><ins class="diffchange diffchange-inline">The original procedure advocated by Kidner involved shelling out </ins>of <ins class="diffchange diffchange-inline">the </ins>accessory navicular bone <ins class="diffchange diffchange-inline">from within </ins>the <ins class="diffchange diffchange-inline">insertional area of the posterior tibial tendon and rerouting this tendon under the navicular bone in hopes of restoring a normal pull of this tendon. When treating younger children</ins>, <ins class="diffchange diffchange-inline">history has shown us that simply shelling out of </ins>the accessory navicular <ins class="diffchange diffchange-inline">bone from within </ins>the <ins class="diffchange diffchange-inline">tendon </ins>and <ins class="diffchange diffchange-inline">remodeling the tuberosity of the navicular bone can give you satisfactory results.<br>In general, you want to reserve advancement of </ins>the posterior tibial tendon for <ins class="diffchange diffchange-inline">adults or those who have a more significant flatfoot deformity. You may also use this approach after determining that quality custom orthotics are only resulting in a slight decrease of symptoms</ins>.</div></td></tr>
</table>Madonna48Zhttp://www.rehime.com.ar/bases/paginasdecine/index.php?title=Extra_Bone_In_Foot_Accessory_Navicular&diff=10875&oldid=prevAllieKhan252219 en 18:45 11 jun 20172017-06-11T18:45:50Z<p></p>
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<td colspan='2' style="background-color: white; color:black; text-align: center;">Revisión de 18:45 11 jun 2017</td>
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<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>Overview<br><del class="diffchange diffchange-inline">The </del>accessory navicular <del class="diffchange diffchange-inline">also termed the os navicularum or os tibiale externum - </del>is an <del class="diffchange diffchange-inline">extra </del>bone <del class="diffchange diffchange-inline">or piece </del>of <del class="diffchange diffchange-inline">cartilage on </del>the <del class="diffchange diffchange-inline">inner side </del>of the <del class="diffchange diffchange-inline">foot above </del>the <del class="diffchange diffchange-inline">arch that attaches to </del>the <del class="diffchange diffchange-inline">posterior tibial tendon within this area</del>. This <del class="diffchange diffchange-inline">extra </del>bone<del class="diffchange diffchange-inline">, </del>present <del class="diffchange diffchange-inline">at birth, is not part of the normal bone structure and found </del>in approximately <del class="diffchange diffchange-inline">10</del>% of the population. <del class="diffchange diffchange-inline">Some people with an accessory navicular </del>may be <del class="diffchange diffchange-inline">unaware of the condition if symptoms are never experienced</del>. <del class="diffchange diffchange-inline">But accessory navicular syndrome is a painful condition caused  by aggravating the bone, the posterior tibial tendon or both.\Accessory navicular syndrome is an irritation of the accessory navicular and/or posterior tibial tendon. This irritation </del>can be <del class="diffchange diffchange-inline">caused by shoe rubbing, trauma, excessive activity, or overuse and can cause problems with the shape and function of your foot. Many people with this disorder also have flat feet which puts more strain on the posterior tibial tendon. Some people are born with an accessory Navicular </del>because <del class="diffchange diffchange-inline">during development, the </del>bones <del class="diffchange diffchange-inline">of the feet sometimes develop abnormally causing the extra bone to form on the inside of the foot</del>.<br><br><br><br>Causes<br><del class="diffchange diffchange-inline">Accessory </del>navicular syndrome <del class="diffchange diffchange-inline">as it is called </del>can result from <del class="diffchange diffchange-inline">a number </del>of <del class="diffchange diffchange-inline">causes</del>, <del class="diffchange diffchange-inline">excess or overuse syndrome </del>as <del class="diffchange diffchange-inline">seen </del>in <del class="diffchange diffchange-inline">an athlete. Trauma to the </del>foot <del class="diffchange diffchange-inline">as in an </del>ankle sprain <del class="diffchange diffchange-inline">or direct trauma to the navicular bone</del>. <del class="diffchange diffchange-inline">chronic </del>irritation from shoes rubbing against the extra bone<del class="diffchange diffchange-inline">, over time, may cause pain</del>. Excessive <del class="diffchange diffchange-inline">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</del>.<br><br>Symptoms<br>The <del class="diffchange diffchange-inline">majority </del>of <del class="diffchange diffchange-inline">people with an </del>accessory navicular <del class="diffchange diffchange-inline">experience no symptoms</del>, <del class="diffchange diffchange-inline">since, for the most part, the little extra </del>bone <del class="diffchange diffchange-inline">simply isn?t large enough to cause problems</del>. <del class="diffchange diffchange-inline">Unfortunately</del>, <del class="diffchange diffchange-inline">some people lose </del>on <del class="diffchange diffchange-inline">?accessory navicular roulette,? and </del>the <del class="diffchange diffchange-inline">bone begins to mess things up with </del>the foot. <del class="diffchange diffchange-inline">These problems usually show up sometime in adolescence, when bones and cartilage </del>in the <del class="diffchange diffchange-inline">body are settling into their final shapes (although occasionally people make it all the way through childhood, only to start experiencing discomfort </del>and <del class="diffchange diffchange-inline">pain in adulthood)</del>.<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://<del class="diffchange diffchange-inline">cindapriess</del>.<del class="diffchange diffchange-inline">hatenablog</del>.<del class="diffchange diffchange-inline">com</del>/<del class="diffchange diffchange-inline">entries</del>/<del class="diffchange diffchange-inline">2015</del>/<del class="diffchange diffchange-inline">08/15 </del>heel spurs] and plantar fasciitis, it?s important to seek treatment.<br><br>Non Surgical Treatment<br><del class="diffchange diffchange-inline">Most cases of </del>accessory navicular <del class="diffchange diffchange-inline">syndrome may </del>be <del class="diffchange diffchange-inline">treated conservatively with some sort of immobilization</del>. <del class="diffchange diffchange-inline">This should allow </del>the <del class="diffchange diffchange-inline">fibrous tissue between the two bones to heal. If a patient is extremely flat footed (pronated) then I lean more towards an orthotic than a boot </del>as <del class="diffchange diffchange-inline">my main goal is to keep the patient's foot from flattening out too much and thus reduce the strain on the two bones. Supplementation with ice</del>, <del class="diffchange diffchange-inline">oral anti-inflammatory medication</del>. <del class="diffchange diffchange-inline">If the patient </del>is <del class="diffchange diffchange-inline">athletic sometimes we can keep them active with an orthotic, but other times they </del>have to <del class="diffchange diffchange-inline">give up their sport for a period of time to allow </del>the <del class="diffchange diffchange-inline">condition to heal</del>.<br><br><br><br>Surgical Treatment<br><del class="diffchange diffchange-inline">If conservative measures do </del>not <del class="diffchange diffchange-inline">seem </del>to <del class="diffchange diffchange-inline">help</del>, <del class="diffchange diffchange-inline">however, you </del>may <del class="diffchange diffchange-inline">need to have surgery to make adjustments to </del>the <del class="diffchange diffchange-inline">bump. This could include reshaping </del>the <del class="diffchange diffchange-inline">little bone</del>, <del class="diffchange diffchange-inline">repairing damage to </del>the posterior tibial tendon<del class="diffchange diffchange-inline">, or even removing the accessory navicular altogether</del>.</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>Overview<br><ins class="diffchange diffchange-inline">An </ins>accessory navicular <ins class="diffchange diffchange-inline">bone </ins>is an <ins class="diffchange diffchange-inline">accessory </ins>bone of the <ins class="diffchange diffchange-inline">foot that occasionally develops abnormally in front </ins>of the <ins class="diffchange diffchange-inline">ankle towards </ins>the <ins class="diffchange diffchange-inline">inside of </ins>the <ins class="diffchange diffchange-inline">foot</ins>. This bone <ins class="diffchange diffchange-inline">may be </ins>present in approximately <ins class="diffchange diffchange-inline">2-14</ins>% of the <ins class="diffchange diffchange-inline">general </ins>population <ins class="diffchange diffchange-inline">and is usually asymptomatic</ins>. <ins class="diffchange diffchange-inline">When it is symptomatic, surgery </ins>may be <ins class="diffchange diffchange-inline">necessary</ins>. <ins class="diffchange diffchange-inline">Surgery </ins>can be <ins class="diffchange diffchange-inline">performed at any age </ins>because <ins class="diffchange diffchange-inline">it does not alter any other </ins>bones.<br><br><br><br>Causes<br><ins class="diffchange diffchange-inline">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 </ins>navicular syndrome <ins class="diffchange diffchange-inline">when the bone and/or posterior tibial tendon are aggravated. This </ins>can result from <ins class="diffchange diffchange-inline">any </ins>of <ins class="diffchange diffchange-inline">the following. Trauma</ins>, as in <ins class="diffchange diffchange-inline">a </ins>foot <ins class="diffchange diffchange-inline">or </ins>ankle sprain. <ins class="diffchange diffchange-inline">Chronic </ins>irritation from shoes <ins class="diffchange diffchange-inline">or other footwear </ins>rubbing against the extra bone. Excessive <ins class="diffchange diffchange-inline">activity or overuse</ins>.<br><br>Symptoms<br>The <ins class="diffchange diffchange-inline">symptoms </ins>of accessory navicular <ins class="diffchange diffchange-inline">syndrome commonly arise during adolescence</ins>, <ins class="diffchange diffchange-inline">when bones are maturing and cartilage fuses into </ins>bone. <ins class="diffchange diffchange-inline">In other instances</ins>, <ins class="diffchange diffchange-inline">symptoms do not appAccessory Navicularear until adulthood. The signs and symptoms include a visible bony prominence </ins>on the <ins class="diffchange diffchange-inline">midfoot the inner side of </ins>the foot <ins class="diffchange diffchange-inline">above the arch</ins>. <ins class="diffchange diffchange-inline">Redness or swelling of the bony prominence. Indistinct pain or throbbing </ins>in the <ins class="diffchange diffchange-inline">midfoot </ins>and <ins class="diffchange diffchange-inline">arch during or after physical activity</ins>.<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://<ins class="diffchange diffchange-inline">Kristiecapria</ins>.<ins class="diffchange diffchange-inline">soup</ins>.<ins class="diffchange diffchange-inline">io</ins>/<ins class="diffchange diffchange-inline">post</ins>/<ins class="diffchange diffchange-inline">594645707</ins>/<ins class="diffchange diffchange-inline">Hammer-Toes </ins>heel spurs] and plantar fasciitis, it?s important to seek treatment.<br><br>Non Surgical Treatment<br><ins class="diffchange diffchange-inline">The treatment for a symptomatic </ins>accessory navicular <ins class="diffchange diffchange-inline">can </ins>be <ins class="diffchange diffchange-inline">divided into nonsurgical treatment and surgical treatment</ins>. <ins class="diffchange diffchange-inline">In </ins>the <ins class="diffchange diffchange-inline">vast majority of cases, treatment usually begins with nonsurgical measures such </ins>as <ins class="diffchange diffchange-inline">orthotics</ins>, <ins class="diffchange diffchange-inline">strappings or bracing</ins>. <ins class="diffchange diffchange-inline">Surgery usually </ins>is <ins class="diffchange diffchange-inline">only considered when all nonsurgical measures </ins>have <ins class="diffchange diffchange-inline">failed </ins>to <ins class="diffchange diffchange-inline">control your problem and </ins>the <ins class="diffchange diffchange-inline">pain becomes intolerable</ins>.<br><br><br><br>Surgical Treatment<br><ins class="diffchange diffchange-inline">Surgery may be an option if non-surgical treatment does </ins>not <ins class="diffchange diffchange-inline">decrease the symptoms of accessory navicular syndrome. Since this bone is not needed for the foot </ins>to <ins class="diffchange diffchange-inline">function normally</ins>, <ins class="diffchange diffchange-inline">Your surgeon </ins>may <ins class="diffchange diffchange-inline">remove </ins>the <ins class="diffchange diffchange-inline">accessory navicular, reshape </ins>the <ins class="diffchange diffchange-inline">area</ins>, <ins class="diffchange diffchange-inline">and repair </ins>the posterior tibial tendon <ins class="diffchange diffchange-inline">for improved function</ins>.</div></td></tr>
</table>AllieKhan252219http://www.rehime.com.ar/bases/paginasdecine/index.php?title=Extra_Bone_In_Foot_Accessory_Navicular&diff=10607&oldid=prevMarianneHubbard en 17:31 11 jun 20172017-06-11T17:31:03Z<p></p>
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<td colspan='2' style="background-color: white; color:black; text-align: center;">Revisión de 17:31 11 jun 2017</td>
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<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>Overview<br><del class="diffchange diffchange-inline">Accessary </del>bone <del class="diffchange diffchange-inline">syndrome affects overpronators because </del>of <del class="diffchange diffchange-inline">irritation in </del>this area. <del class="diffchange diffchange-inline">Improper fitting shoes can also irritate </del>the <del class="diffchange diffchange-inline">area</del>. <del class="diffchange diffchange-inline">When pain becomes such that it changes running form or becomes intolerable, something needs to </del>be <del class="diffchange diffchange-inline">done</del>. <del class="diffchange diffchange-inline">Surgery alone without addressing causative factors </del>is <del class="diffchange diffchange-inline">useless</del>. <del class="diffchange diffchange-inline">Pain returns and new cartilage returns in </del>the tendon, and the <del class="diffchange diffchange-inline">inflammation causes pain</del>.<br><br><br><br>Causes<br><del class="diffchange diffchange-inline">An injury to the fibrous tissue connecting the two bones </del>can <del class="diffchange diffchange-inline">cause something similar to </del>a <del class="diffchange diffchange-inline">fracture</del>. <del class="diffchange diffchange-inline">The injury allows movement </del>to <del class="diffchange diffchange-inline">occur between </del>the navicular <del class="diffchange diffchange-inline">and </del>the <del class="diffchange diffchange-inline">accessory </del>bone <del class="diffchange diffchange-inline">and is thought to be the cause of pain. The fibrous tissue is prone to poor healing and </del>may <del class="diffchange diffchange-inline">continue to </del>cause pain. <del class="diffchange diffchange-inline">Because </del>the posterior <del class="diffchange diffchange-inline">tibial tendon attaches to </del>the <del class="diffchange diffchange-inline">accessory </del>navicular, <del class="diffchange diffchange-inline">it constantly pulls on </del>the bone, <del class="diffchange diffchange-inline">creating even more motion between </del>the <del class="diffchange diffchange-inline">fragments with each step</del>.<br><br>Symptoms<br><del class="diffchange diffchange-inline">Adolescence is a common time </del>for the <del class="diffchange diffchange-inline">symptoms </del>to <del class="diffchange diffchange-inline">first appear</del>. <del class="diffchange diffchange-inline">This is a time when bones are maturing and cartilage is developing into bone. Sometimes</del>, <del class="diffchange diffchange-inline">however</del>, the <del class="diffchange diffchange-inline">symptoms do not occur until adulthood</del>. <del class="diffchange diffchange-inline">The signs </del>and <del class="diffchange diffchange-inline">symptoms of accessory navicular syndrome include a visible bony prominence on </del>the <del class="diffchange diffchange-inline">midfoot </del>(the <del class="diffchange diffchange-inline">inner side of the foot</del>, <del class="diffchange diffchange-inline">just above the arch) Redness </del>and <del class="diffchange diffchange-inline">swelling of the bony prominence. Vague </del>pain <del class="diffchange diffchange-inline">or throbbing </del>in <del class="diffchange diffchange-inline">the midfoot and arch, usually occurring during or after periods of activity</del>.<br><br>Diagnosis<br><del class="diffchange diffchange-inline">Plain x-rays are used to determine the size of the </del>accessory navicular. <del class="diffchange diffchange-inline">There are three main types of accessory navicular bones: </del> <del class="diffchange diffchange-inline">a small bone embedded within </del>the <del class="diffchange diffchange-inline">nearby posterior tibial tendon; a triangular shaped </del>bone <del class="diffchange diffchange-inline">connected to the navicular by thick cartilage; </del>and <del class="diffchange diffchange-inline">a large prominent navicular tuberosity thought to represent an accessory navicular that has fused to </del>the <del class="diffchange diffchange-inline">navicular</del>. <del class="diffchange diffchange-inline">If </del>the <del class="diffchange diffchange-inline">status of the posterior tibial tendon needs to be assessed </del>or <del class="diffchange diffchange-inline">if </del>other <del class="diffchange diffchange-inline">problems are suspected, (ex. Navicular stress fracture) it </del>may be <del class="diffchange diffchange-inline">necessary </del>to <del class="diffchange diffchange-inline">perform an MRI. Although this is not considered routine, an MRI may be helpful in identifying the degree of </del>irritation<del class="diffchange diffchange-inline">. An MRI would demonstrate fluid </del>or <del class="diffchange diffchange-inline">edema that may accumulate in the bone </del>as <del class="diffchange diffchange-inline">a result of the </del>irritation.<br><br>Non Surgical Treatment<br><del class="diffchange diffchange-inline">In order </del>to <del class="diffchange diffchange-inline">strengthen your muscles to prevent further injury and to provide support </del>to the foot<del class="diffchange diffchange-inline">, your podiatrist may also outline a physical therapy routine </del>and <del class="diffchange diffchange-inline">prescribe orthotics</del>. <del class="diffchange diffchange-inline">Orthotics will provide support to </del>the <del class="diffchange diffchange-inline">arch of your foot</del>, <del class="diffchange diffchange-inline">although </del>they <del class="diffchange diffchange-inline">must be carefully crafted in order </del>to <del class="diffchange diffchange-inline">make room </del>for <del class="diffchange diffchange-inline">that pesky extra bone you?ve got poking about</del>.<br><br><br><br>Surgical Treatment<br>If <del class="diffchange diffchange-inline">non-operative treatment fails </del>to <del class="diffchange diffchange-inline">relieve the patient’s symptoms</del>, <del class="diffchange diffchange-inline">surgical intervention </del>may <del class="diffchange diffchange-inline">be warranted</del>. <del class="diffchange diffchange-inline">The standard operative treatment of an accessory navicular is a Kidner procedure.  However</del>, <del class="diffchange diffchange-inline">if surgery is undertaken it is important that it address </del>the <del class="diffchange diffchange-inline">underlying source of </del>the <del class="diffchange diffchange-inline">patients pain</del>.</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>Overview<br><ins class="diffchange diffchange-inline">The accessory navicular also termed the os navicularum or os tibiale externum - is an extra </ins>bone <ins class="diffchange diffchange-inline">or piece </ins>of <ins class="diffchange diffchange-inline">cartilage on the inner side of the foot above the arch that attaches to the posterior tibial tendon within </ins>this area. <ins class="diffchange diffchange-inline">This extra bone, present at birth, is not part of </ins>the <ins class="diffchange diffchange-inline">normal bone structure and found in approximately 10% of the population</ins>. <ins class="diffchange diffchange-inline">Some people with an accessory navicular may </ins>be <ins class="diffchange diffchange-inline">unaware of the condition if symptoms are never experienced</ins>. <ins class="diffchange diffchange-inline">But accessory navicular syndrome </ins>is <ins class="diffchange diffchange-inline">a painful condition caused  by aggravating the bone, the posterior tibial tendon or both</ins>.<ins class="diffchange diffchange-inline">\Accessory navicular syndrome is an irritation of </ins>the <ins class="diffchange diffchange-inline">accessory navicular and/or posterior tibial </ins>tendon<ins class="diffchange diffchange-inline">. This irritation can be caused by shoe rubbing</ins>, <ins class="diffchange diffchange-inline">trauma, excessive activity, or overuse </ins>and <ins class="diffchange diffchange-inline">can cause problems with </ins>the <ins class="diffchange diffchange-inline">shape and function of your foot. Many people with this disorder also have flat feet which puts more strain on the posterior tibial tendon. Some people are born with an accessory Navicular because during development, the bones of the feet sometimes develop abnormally causing the extra bone to form on the inside of the foot</ins>.<br><br><br><br>Causes<br><ins class="diffchange diffchange-inline">Accessory navicular syndrome as it is called </ins>can <ins class="diffchange diffchange-inline">result from </ins>a <ins class="diffchange diffchange-inline">number of causes, excess or overuse syndrome as seen in an athlete</ins>. <ins class="diffchange diffchange-inline">Trauma to the foot as in an ankle sprain or direct trauma </ins>to the navicular <ins class="diffchange diffchange-inline">bone. chronic irritation from shoes rubbing against </ins>the <ins class="diffchange diffchange-inline">extra </ins>bone<ins class="diffchange diffchange-inline">, over time, </ins>may cause pain. <ins class="diffchange diffchange-inline">Excessive pronation which strains </ins>the <ins class="diffchange diffchange-inline">attachment of tibialis </ins>posterior <ins class="diffchange diffchange-inline">muscles into </ins>the navicular <ins class="diffchange diffchange-inline">bone. Keep in mind</ins>, the <ins class="diffchange diffchange-inline">larger the actual accessory </ins>bone, the <ins class="diffchange diffchange-inline">greater the chance of it becoming an issue</ins>.<br><br>Symptoms<br><ins class="diffchange diffchange-inline">The majority of people with an accessory navicular experience no symptoms, since, </ins>for the <ins class="diffchange diffchange-inline">most part, the little extra bone simply isn?t large enough </ins>to <ins class="diffchange diffchange-inline">cause problems</ins>. <ins class="diffchange diffchange-inline">Unfortunately</ins>, <ins class="diffchange diffchange-inline">some people lose on ?accessory navicular roulette</ins>,<ins class="diffchange diffchange-inline">? and </ins>the <ins class="diffchange diffchange-inline">bone begins to mess things up with the foot</ins>. <ins class="diffchange diffchange-inline">These problems usually show up sometime in adolescence, when bones </ins>and <ins class="diffchange diffchange-inline">cartilage in </ins>the <ins class="diffchange diffchange-inline">body are settling into their final shapes </ins>(<ins class="diffchange diffchange-inline">although occasionally people make it all </ins>the <ins class="diffchange diffchange-inline">way through childhood</ins>, <ins class="diffchange diffchange-inline">only to start experiencing discomfort </ins>and pain in <ins class="diffchange diffchange-inline">adulthood)</ins>.<br><br>Diagnosis<br><ins class="diffchange diffchange-inline">To diagnose </ins>accessory navicular <ins class="diffchange diffchange-inline">syndrome, medical staff ask about the patient?s activities and symptoms</ins>. <ins class="diffchange diffchange-inline">They will examine the foot for irritation or swelling. Medical staff </ins> <ins class="diffchange diffchange-inline">evaluate </ins>the bone <ins class="diffchange diffchange-inline">structure, muscle, joint motion, </ins>and the <ins class="diffchange diffchange-inline">patient?s gait</ins>. <ins class="diffchange diffchange-inline">X-rays can usually confirm </ins>the <ins class="diffchange diffchange-inline">diagnosis. MRI </ins>or other <ins class="diffchange diffchange-inline">imaging tests </ins>may be <ins class="diffchange diffchange-inline">used </ins>to <ins class="diffchange diffchange-inline">determine any </ins>irritation or <ins class="diffchange diffchange-inline">damage to soft-tissue structures such </ins>as <ins class="diffchange diffchange-inline">tendons or ligaments. Because navicular accessory bone </ins>irritation <ins class="diffchange diffchange-inline">can lead to bunions, [http://cindapriess.hatenablog.com/entries/2015/08/15 heel spurs] and plantar fasciitis, it?s important to seek treatment</ins>.<br><br>Non Surgical Treatment<br><ins class="diffchange diffchange-inline">Most cases of accessory navicular syndrome may be treated conservatively with some sort of immobilization. This should allow the fibrous tissue between the two bones </ins>to <ins class="diffchange diffchange-inline">heal. If a patient is extremely flat footed (pronated) then I lean more towards an orthotic than a boot as my main goal is </ins>to <ins class="diffchange diffchange-inline">keep </ins>the <ins class="diffchange diffchange-inline">patient's </ins>foot <ins class="diffchange diffchange-inline">from flattening out too much </ins>and <ins class="diffchange diffchange-inline">thus reduce the strain on the two bones</ins>. <ins class="diffchange diffchange-inline">Supplementation with ice, oral anti-inflammatory medication. If </ins>the <ins class="diffchange diffchange-inline">patient is athletic sometimes we can keep them active with an orthotic</ins>, <ins class="diffchange diffchange-inline">but other times </ins>they <ins class="diffchange diffchange-inline">have </ins>to <ins class="diffchange diffchange-inline">give up their sport </ins>for <ins class="diffchange diffchange-inline">a period of time to allow the condition to heal</ins>.<br><br><br><br>Surgical Treatment<br>If <ins class="diffchange diffchange-inline">conservative measures do not seem </ins>to <ins class="diffchange diffchange-inline">help</ins>, <ins class="diffchange diffchange-inline">however, you </ins>may <ins class="diffchange diffchange-inline">need to have surgery to make adjustments to the bump</ins>. <ins class="diffchange diffchange-inline">This could include reshaping the little bone</ins>, <ins class="diffchange diffchange-inline">repairing damage to </ins>the <ins class="diffchange diffchange-inline">posterior tibial tendon, or even removing </ins>the <ins class="diffchange diffchange-inline">accessory navicular altogether</ins>.</div></td></tr>
</table>MarianneHubbard