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Foot Accessory Navicular Excision

May 6, 2017
Overview

An accessory navicular is defined as an extra bone in the foot, and oftentimes it causes moderate to severe discomfort. Depending on the severity, your doctor may recommend a non-surgical treatment to alleviate the pain, or surgery if treatment doesn?t decrease symptoms.

Accessory Navicular

Causes

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.

Symptoms

It?s common for any symptoms to present during adolescence, when bones are maturing, though problems may not occur until adulthood. You may notice a bony prominence on the inner side of the midfoot. There may or may not be redness and swelling around this bump, especially if it rubs against footwear. You may be prone to blisters or sores in the area. Pain generally involves a vague ache or throbbing in the midfoot and arch as well, especially when you?re active. Many people with this syndrome develop flat feet, too, which can create additional strain in the foot.

Diagnosis

To diagnose accessory navicular syndrome, the foot and ankle surgeon will ask about symptoms and examine the foot, looking for skin irritation or s welling. The doctor may press on the bony prominence to assess the area for discomfort. Foot structure, muscle strength, joint motion, and the way the patient walks may also be evaluated. X-rays are usually ordered to confirm the diagnosis. If there is ongoing pain or inflammation, an MRI or other advanced imaging tests may be used to further evaluate the condition.

Non Surgical Treatment

If the foot becomes painful following a twisting type of injury and an X-ray reveals the presence of an accessory navicular bone, your doctor may recommend a period of immobilization in a cast or splint. This will rest the foot and perhaps allow the disruption between the navicular and accessory navicular to heal. Your doctor may prescribe anti-inflammatory medication. Sometimes an arch support can relieve the stress on the fragment and decrease the symptoms. If the pain subsides and the fragment becomes asymptomatic, further treatment may not be necessary.

Accessory Navicular Syndrome

Surgical Treatment

If all nonsurgical measures fail and the fragment continues to be painful, surgery may be recommended. The most common procedure used to treat the symptomatic accessory navicular is the Kidner procedure. A small incision is made in the instep of the foot over the accessory navicular. The accessory navicular is then detached from the posterior tibial tendon and removed from the foot. The posterior tibial tendon is reattached to the remaining normal navicular. Following the procedure, the skin incision is closed with stitches, and a bulky bandage and splint are applied to the foot and ankle. You may need to use crutches for several days after surgery. Your stitches will be removed in 10 to 14 days (unless they are the absorbable type, which will not need to be taken out). You should be safe to be released to full activity in about six weeks.

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