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Overview
Everyone has one navicular bone: one of the small bones of the foot. A small number of people have a second small navicular bone or piece of cartilage located on the inside of the foot just above the arch: both are simply called an "accessary navicular bone." It is located within the posterior tibial tendon which attaches in this area. It is easy to see as a "bump." Most that have it never have pain. If they get pain, we call it: "Accessary navicular bone syndrome."

Accessory Navicular Syndrome

Causes
Just having an accessory navicular bone is not necessarily a bad thing. Not all people with these accessory bones have symptoms. Symptoms arise when the accessory navicular is overly large or when an injury disrupts the fibrous tissue between the navicular and the accessory navicular. A very large accessory navicular can cause a bump on the instep that rubs on your shoe causing pain.

Symptoms
The primary reason an accessory navicular becomes a problem is pain. There is no need to do anything with an accessory navicular that is not causing pain. The pain is usually at the instep area and can be pinpointed over the small bump in the instep. Walking can be painful when the problem is aggravated. As stated earlier, the condition What is leg length discrepancy? more common in girls. The problem commonly becomes symptomatic in the teenage years.

Diagnosis
Diagnosis is fairly simple based on an examination by your doctor. He or she will palpate the navicular bone, and based on the location of pain will suspect an accessory navicular. The doctor will also observe your gait to see if you are flatfooted. At this point an x-ray will make the definitive diagnosis. Other causes of pain in the same area of the foot would include a fracture of the navicular bone or possibly tendonitis or even a partial tear of the tibialis posterior tendon that inserts into the navicular. In these cases there is usually a history of trauma. People with a naturally "large" navicular bone may also develop a bursitis due to chronic shoe pressure.

Non Surgical Treatment
Fortunately, surgery is not the only answer when it comes to relieving symptoms of accessory navicular syndrome. The physician may recommend wearing a cast or walking boot for a period of time so the foot can recover from the inflammation. Ice may be used to relieve swelling, too, although it should be wrapped to avoid direct contact with the skin.

Accessory Navicular

Surgical Treatment
For patients who have failed conservative care or who have had recurrent symptoms, surgery can be considered. Surgical intervention requires an excision of the accessory navicular and reattachment of the posterior tibial tendon to the navicular. Often times, this is the only procedure necessary. However, if there are other deformities such as a flat foot or forefoot that is abducted, other procedures may be required.



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تاريخ : يکشنبه 16 مهر 1396 | 13:02 | نویسنده : Willard Bodin |