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Overview<br>The bones of the foot occasionally develop abnormally in a child and an extra bone called an accessory navicular is present towards the inside of the foot, in front of the ankle. This bone is present in approximately 10% of the general population but not large enough to cause symptoms in the majority of these individuals. The extra bone lump present in childhood can be quite uncomfortable because it rubs on shoes. In addition, the feet associated with the accessory navicular are invariably flat. If the child is active and involved in various athletic activities, this will aggravate the inflammation of the tendon that attaches to the 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 treatment.<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>Many people have accessory (?extra?) naviculars (figure 1) - a prominent extra bone extending from the navicular bone. Most accessory naviculars are completely asymptomatic. However, some individuals will develop pain on the inside of their midfoot. Pain may occur from the pressure of the shoe ware against the prominence, irritating either the bone itself or the fibrous junction where the accessory bone meets the regular navicular. Alternatively, the fibrous junction or interface may become painful as a result of tension applied by the posterior tibial tendon through its connection or insertion at that site. Often, individuals will be asymptomatic for years, however, a new pair of shoes or a change in their activity level can cause symptoms. The accessory navicular itself typically develops during adolescence, when the two areas of the navicular bone fail to fuse together.<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://tamathagrahn.hatenablog.com/entries/2015/07/22 heel spurs] and plantar fasciitis, it?s important to seek treatment.<br><br>Non Surgical Treatment<br>Ideally, getting rid of the symptoms of accessory navicular syndrome will involve soothing the inflammation and irritation in your foot. So, for starters, your podiatrist may have you rest the area, allowing the inflamed tendon and bone to heal. This may be accomplished by wearing a cast or boot designed to keep you from moving the problem area. Your podiatrist may also suggest using ice to reduce the swelling and inflammation, and anti-inflammatory medications (like ibuprofen, or sometimes a cortisone shot or other steroid medication).<br><br><br><br>Surgical Treatment<br>Depending upon the severity the non operative or conservative treatment should be maintained for at least 4- 6 months before any surgical intervention. There are 2 surgeries that can be performed depending upon the condition and symptoms. First is simple surgical excision. In this generally the accessory navicular along with its prominence is removed. In this procedure, skin incision is made dorsally to the prominence of accessory navicular. Bone is removed to the point where the medial foot has no bony prominence over the navicular, between the head of the talus and first cuneiform. Symptoms are relieved in 90% of cases. Second is Kindler procedure. In this the ossicle and navicular prominence is excised as in simple excision but along with the posterior tibial tendon advancement. Posterior tibial tendon is split and advanced along the medial side of foot to provide support to longitudinal arch. After surgery 4 week short leg cast, well moulded into the arch with the foot plantigrade is applied. Partial weight bearing till the 8th week and later full weight bearing is allowed. When the cast is being removed can start building up the ROM to counter atrophy and other physical therapy treatment which include stretching and strengthening exercises.
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Overview<br>For most people with an accessory navicular, the extra bone does not cause any problems and most are unaware of its presence. But certain activities or circumstances may cause the extra bone or the tibialis posterior tendon that contains it to grow irritated. This is called accessory navicular syndrome, and its possible causes include sprains, overuse, or wearing shoes that constantly rub against the bone. Individuals who have a collapsed arch (commonly known as flat feet) may be at greater risk of accessory navicular syndrome, assuming they have the extra bone, because of the added daily trauma placed on the tibialis posterior tendon.<br><br><br><br>Causes<br>The syndrome may result from any of the following, previous trauma such as a foot or ankle sprain. Chronic irritation from shoes or other footwear causing friction against the bone. Strain from overuse or excessive activity.<br><br>Symptoms<br>Symptoms of accessory navicular include. Bone lump on the inside of the foot. Redness and swelling. Pain.<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://hyewlodarczyk.blog.Fc2.com/blog-entry-5.html heel spurs] and plantar fasciitis, it?s important to seek treatment.<br><br>Non Surgical Treatment<br>Initial treatment is conservative. With the first episode of symptoms, a medial heel wedge, anti-inflammatories, and physical therapy can be helpful. If very painful, a cast or boot may be needed for a short period time before the wedge and physical therapy can be initiated. Very rarely is a steroid injection warranted or recommended. As the pain improves, patients can resume activities. For a minority of patients, an arch support or custom orthotic can help to take some of the extra pressure off of the accessory navicular and the posterior tibial tendon.<br><br><br><br>Surgical Treatment<br>Surgery may be an option if non-surgical treatment does not decrease the symptoms of accessory navicular syndrome. Since this bone is not needed for the foot to function normally, Your surgeon may remove the accessory navicular, reshape the area, and repair the posterior tibial tendon for improved function.

Última revisión de 05:26 12 jun 2017

Overview
For most people with an accessory navicular, the extra bone does not cause any problems and most are unaware of its presence. But certain activities or circumstances may cause the extra bone or the tibialis posterior tendon that contains it to grow irritated. This is called accessory navicular syndrome, and its possible causes include sprains, overuse, or wearing shoes that constantly rub against the bone. Individuals who have a collapsed arch (commonly known as flat feet) may be at greater risk of accessory navicular syndrome, assuming they have the extra bone, because of the added daily trauma placed on the tibialis posterior tendon.



Causes
The syndrome may result from any of the following, previous trauma such as a foot or ankle sprain. Chronic irritation from shoes or other footwear causing friction against the bone. Strain from overuse or excessive activity.

Symptoms
Symptoms of accessory navicular include. Bone lump on the inside of the foot. Redness and swelling. Pain.

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
Initial treatment is conservative. With the first episode of symptoms, a medial heel wedge, anti-inflammatories, and physical therapy can be helpful. If very painful, a cast or boot may be needed for a short period time before the wedge and physical therapy can be initiated. Very rarely is a steroid injection warranted or recommended. As the pain improves, patients can resume activities. For a minority of patients, an arch support or custom orthotic can help to take some of the extra pressure off of the accessory navicular and the posterior tibial tendon.



Surgical Treatment
Surgery may be an option if non-surgical treatment does not decrease the symptoms of accessory navicular syndrome. Since this bone is not needed for the foot to function normally, Your surgeon may remove the accessory navicular, reshape the area, and repair the posterior tibial tendon for improved function.

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