Accessory Navicular

What is an Accessory Navicular and its Treatment?

An accessory navicular is an extra piece of bone or cartilage located on the inner side of the foot, near the navicular bone. While not always problematic, it can lead to discomfort or pain, especially during physical activity or when wearing tight shoes. Understanding its diagnosis and treatment options is essential for managing this condition effectively.

Symptoms

Symptoms of an accessory navicular may include localized pain, swelling, and tenderness over the prominence on the inner side of the foot. Pain typically worsens with activity and may improve with rest. In some cases, the presence of an accessory navicular may contribute to flat feet or pronation, leading to additional symptoms such as arch pain or ankle instability.

Diagnosis

Diagnosing an accessory navicular involves a physical examination to assess for tenderness and swelling over the affected area. X-rays may be ordered to confirm the presence of the accessory bone and evaluate its size and shape. Additionally, MRI or CT scans may be used to assess for associated soft tissue abnormalities or ligament injuries.

Non-surgical Treatment

Initial treatment for an accessory navicular typically involves conservative measures to alleviate symptoms. This may include rest, ice, and anti-inflammatory medications to reduce pain and inflammation. Orthotic devices, such as arch supports or custom shoe inserts, may help redistribute pressure away from the affected area and provide additional support to the foot. Physical therapy exercises focused on strengthening the muscles of the foot and ankle and improving flexibility may also be beneficial.

Surgical Treatment

If conservative measures fail to provide relief, surgical intervention may be considered. The goal of surgery is to remove the accessory navicular and repair any associated soft tissue abnormalities, such as tendon inflammation or ligament laxity. This may involve a procedure known as accessory navicular excision, in which the extra piece of bone is removed through a small incision on the inner side of the foot. In some cases, additional procedures, such as tendon transfers or ligament repairs, may be performed to address underlying structural issues and restore normal foot mechanics.

Recovery

Recovery following surgery for an accessory navicular typically involves a period of immobilization in a cast or walking boot to allow for proper healing. Physical therapy may be initiated to restore strength, range of motion, and function to the foot and ankle. Patients are typically advised to avoid weight-bearing activities and high-impact exercise for several weeks following surgery, gradually increasing activity levels as tolerated. Full recovery may take several months, depending on the extent of the surgical procedure and individual healing response.

Is there anything I can do to prevent an accessory navicular?

While the development of an accessory navicular is often congenital and cannot be prevented, certain measures may help reduce the risk of symptoms or complications. This includes wearing supportive footwear with adequate arch support and cushioning, avoiding activities that exacerbate pain or discomfort, and maintaining a healthy weight to reduce stress on the feet and ankles.

After surgical removal of an accessory navicular, how likely am I to experience symptoms again?

The success rate of surgical treatment for an accessory navicular is generally high, with most patients experiencing significant relief of symptoms and improved foot function. However, there is always a risk of recurrence or persistent symptoms, especially if underlying biomechanical issues are not addressed. Adhering to post-operative instructions and engaging in appropriate rehabilitation exercises can help optimize outcomes and minimize the risk of complications.