Orthopedic Expertise for Accessory Navicular Syndrome

Risk Factors for Accessory Navicular Syndrome

It’s unclear why some people are born with an extra piece of cartilage. The presence of an accessory navicular is significantly higher in Asian people and the condition can run in families.

Accessory navicular syndrome may occur if the posterior tibial tendon becomes inflamed and irritates the accessory navicular. Risk factors for inflammation of the tendon include:

• Flat feet. Also known as fallen arches, flat feet puts additional strain on the posterior tibial tendon, which can lead to inflammation.
• Traumatic injury to the foot such as an ankle sprain or fracture.
• Excessive activity or overuse.

Symptoms of Accessory Navicular Syndrome

Most people with an accessory navicular bone are unaware of it and never experience any symptoms. If accessory navicular syndrome develops, symptoms usually start during adolescence or young adulthood when the cartilage is hardening into bone. Symptoms may include:

• Pain, redness or swelling in the arch of the foot, often during or after periods of activity.
• Pain with weightbearing.
• A visible bony bump on the midfoot.
• Difficulty walking without a limp.

If you experience any of these symptoms and they are interfering with your quality of life, you should be evaluated by a foot and ankle specialist.

Diagnosis

To diagnose accessory navicular syndrome, our specialists will first take a complete medical and lifestyle history. You will be asked to describe your symptoms and your foot will be examined for irritation and swelling. If there is a visible bony bump, the doctor may gently press on it to assess for pain. You will also be asked to walk so the doctor can evaluate your gait.

If accessory navicular syndrome is suspected, the presence of the extra bone will be confirmed with an X-ray. Additional, advanced imaging exams like MRI may be done to further evaluate symptoms of pain and inflammation.

Conservative Treatments

Initial treatments are usually conservative and designed to relieve symptoms. Your doctor may recommend rest and one or more of the following:

• Immobilization of the foot with a cast or medical boot.
• Icing and elevation to reduce swelling.
• Nonsteroidal anti-inflammatory medications (NSAIDs) like ibuprofen.
• Oral or injected steroid medications to reduce pain and inflammation.
• Physical therapy to stretch and strengthen the muscles and tendons involved.
• Custom orthotic devices to provide support for the arch, especially if flat feet are an issue.

If conservative treatment approaches don’t relieve symptoms or if symptoms reappear, surgery may be recommended.

Surgical Treatment of Accessory Navicular Syndrome

Surgery may involve removing the accessory bone, reshaping the area and repairing the posterior tibial tendon if damaged. Removal of this extra bone will not affect normal foot function.

This is an outpatient procedure and recovery usually requires four weeks of rest in a cast, splint or walking boot.