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Overview<br>The accessory navicular (os navicularum or os tibiale externum) is an extra bone or piece of cartilage located on the inner side of the foot just above the arch. It is incorporated within the posterior tibial tendon, which attaches in this area. An accessory navicular is congenital (present at birth). It is not part of normal bone structure and therefore is not present in most people. People who have an accessory navicular often are unaware of the condition if it causes no problems. However, some people with this extra bone develop a painful condition known as accessory navicular syndrome when the bone and/or posterior tibial tendon are aggravated. 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><br><br>Causes<br>An injury to the fibrous tissue connecting the two bones can cause something similar to a fracture. The injury allows movement to occur between the navicular and the accessory bone and is thought to be the cause of pain. The fibrous tissue is prone to poor healing and may continue to cause pain. Because the posterior tibial tendon attaches to the accessory navicular, it constantly pulls on the bone, creating even more motion between the fragments with each step.<br><br>Symptoms<br>Many people with an accessory navicular do not experience symptoms, however some may notice a bump and/or swelling on the inside of the foot just above the arch. They may also experience pain in the middle of the foot, particularly with physical activity.<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://Hammondulwahtchul.Page.tl/New-Hammertoe-Surgery.htm heel spurs] and plantar fasciitis, it?s important to seek treatment.<br><br>Non Surgical Treatment<br>The goal of non-surgical treatment for accessory navicular syndrome is to relieve the symptoms. The following may be used. Immobilization. Placing the foot in a cast or removable walking boot allows the affected area to rest and decreases the inflammation. Ice. To reduce swelling, a bag of ice covered with a thin towel is applied to the affected area. Do not put ice directly on the skin. Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be prescribed. In some cases, oral or injected steroid medications may be used in combination with immobilization to reduce pain and inflammation. Physical therapy. Physical therapy may be prescribed, including exercises and treatments to strengthen the muscles and decrease inflammation. The exercises may also help prevent recurrence of the symptoms. Orthotic devices. Custom orthotic devices that fit into the shoe provide support for the arch, and may play a role in preventing future symptoms. Even after successful treatment, the symptoms of accessory navicular syndrome sometimes reappear.  When this happens, non-surgical approaches are usually repeated.<br><br><br><br>Surgical Treatment<br>In my experience, the Modified Kidner procedure is one of the most reliable operations for reducing arch pain associated with an accessory navicular bone (a.k.a. os tibial externum). You can also use this procedure to treat a prominence at the inner aspect of the arch, which has been caused by an enlarged navicular bone. The most common patients to visit our office with these problems are between the ages of 8 and 15 and are involved in activities like ice skating, ballet and soccer.
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Overview<br>Accessory navicular describes the presence of an extra bone growth center on the inside of the navicular and within the posterial tibial tendon that attaches to the navicular. The primary symptom from this additional bony prominence is pain and tenderness. This congenital defect (present at birth) is thought to occur during development when the bone is calcifying. Because this accessory portion of the bone and the navicular never quite grow together, it is believed that, over time, the excessive motion between the two bones results in pain.<br><br><br><br>Causes<br>Let us see the reasons why the tendon or the bone would get aggravated. Ankle or foot sprain, irritation of the bone caused by footwear, overusing the foot, quite common in athletes and dancers. People born with this extra bone are also known develop flat feet which also adds to the strain on the posterior tibial tendon and lead to the syndrome.<br><br>Symptoms<br>Most people born with this bone begin to experience the symptoms (if at all any) in adolescence. Some may not develop any symptoms until adulthood. The symptoms are a visible abnormal protrusion in the mid-foot, swelling and redness of the protrusion, pain in the mid-foot after performing an activity.<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://lazyenthusiast476.hazblog.com/ heel spurs] and plantar fasciitis, it?s important to seek treatment.<br><br>Non Surgical Treatment<br>Although operative treatment, and removal of the accessory navicular is possible, this is not usually indicated at first. Conservative nonoperative treatment is best, the course depending on the severity of the symptoms. When the pain is very severe, which could indicate a fracture, a period of immobilization might be required. This is done by waring a fracture boot, or a cast, which can help the ossicle stay stable, aiding in healing. Immobilization usually lasts between 4 to 6 weeks. Afterwards, physical therapy exercise, or any appropriate home course, should be used to help strengthen the ankle and return the ankle and foot to full range of motion, and have no pain on movement. Sometimes crutches are used when weight bearing is too painful, but it is best to try to bear weight when possible.<br><br><br><br>Surgical Treatment<br>The original procedure advocated by Kidner involved shelling out of the accessory navicular bone from within the 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, history has shown us that simply shelling out of the accessory navicular bone from within the tendon and remodeling the tuberosity of the navicular bone 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.

Revisión de 01:20 12 jun 2017

Overview
Accessory navicular describes the presence of an extra bone growth center on the inside of the navicular and within the posterial tibial tendon that attaches to the navicular. The primary symptom from this additional bony prominence is pain and tenderness. This congenital defect (present at birth) is thought to occur during development when the bone is calcifying. Because this accessory portion of the bone and the navicular never quite grow together, it is believed that, over time, the excessive motion between the two bones results in pain.



Causes
Let us see the reasons why the tendon or the bone would get aggravated. Ankle or foot sprain, irritation of the bone caused by footwear, overusing the foot, quite common in athletes and dancers. People born with this extra bone are also known develop flat feet which also adds to the strain on the posterior tibial tendon and lead to the syndrome.

Symptoms
Most people born with this bone begin to experience the symptoms (if at all any) in adolescence. Some may not develop any symptoms until adulthood. The symptoms are a visible abnormal protrusion in the mid-foot, swelling and redness of the protrusion, pain in the mid-foot after performing an activity.

Diagnosis
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, heel spurs and plantar fasciitis, it?s important to seek treatment.

Non Surgical Treatment
Although operative treatment, and removal of the accessory navicular is possible, this is not usually indicated at first. Conservative nonoperative treatment is best, the course depending on the severity of the symptoms. When the pain is very severe, which could indicate a fracture, a period of immobilization might be required. This is done by waring a fracture boot, or a cast, which can help the ossicle stay stable, aiding in healing. Immobilization usually lasts between 4 to 6 weeks. Afterwards, physical therapy exercise, or any appropriate home course, should be used to help strengthen the ankle and return the ankle and foot to full range of motion, and have no pain on movement. Sometimes crutches are used when weight bearing is too painful, but it is best to try to bear weight when possible.



Surgical Treatment
The original procedure advocated by Kidner involved shelling out of the accessory navicular bone from within the 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, history has shown us that simply shelling out of the accessory navicular bone from within the tendon and remodeling the tuberosity of the navicular bone can give you satisfactory results.
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.

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