On several foot x-rays, an auxiliary (extra) navicular bone is a frequent occurrence. In certain cases, however, the conspicuous bone on the inside of the foot will cause pain, which contributes to shoe-wearing difficulties. Alternatively, it can aggravate the tissue between the navicular bone and the "extra" accessory portion and cause discomfort. Via clinical evaluation and clear x-rays of the foot, diagnosis is accomplished. Treatment is typically non-operational, sometimes requiring a shoe wear alteration, alteration of movement, and often an insole to relieve the sore area. However, patients who have continuing complications after seeking non-surgical intervention often recommend surgery to remove the noticeable navicular attachment and, if possible, to realign the posterior tibial tendon.
Many individuals have accessory naviculars, a prominent additional bone that spreads from the navicular bone. Normally symptomless are most accessory naviculars. However, on the inside of your midfoot, certain people will develop discomfort. The pressure of the shoe wear against the elevation may cause discomfort, which irritates either the bone itself or the fibrous junction where the attachment bone meets the normal navicular. Alternatively, as a result of stress exerted by the posterior tibial tendon via its attachment or insertion at that location, the fibrous tissue or interface can become painful. Individuals can often have no problems for years, but a new pair of sneakers or a change in their level of physical activity may cause symptoms.
During puberty, when the two components of the navicular bone fail to fuse properly, the accessory navicular itself usually develops. There will always be a bony appearance on the inside of the foot, a little below and in front of the inner ankle bone (medial malleolus) when evaluating afoot with an indicative navicular accessory. The scale can range from minimal to very large for this prominence. It will sometimes cause discomfort to push over this area.
A related flat foot deformity may occur, and this can cause symptoms with a navicular accessory system. The symptoms may be exacerbated by pressuring the posterior tibial tendon by lifting the heel up and down on one foot, or by pressing the foot against tension inside, as these movements stress the posterior tibial tendon attached to the inside of the accessory navicular bone. Owing to the pain, patients can walk with a noticeable limp.
If the patient's symptoms are not relieved by non - operative care, surgical treatment may be required. A Kidner operation is the usual surgical treatment of a navicular accessory. However, if surgery is performed, it is necessary to resolve the fundamental cause of pain in the patient. Management with surgical care can include:
The Kidner technique includes resecting the prominent navicular accessory and maintaining that the bone is still connected to the posterior tibial tendon. Sometimes, compared to the posterior tibial tendon, which keeps the tendon intact, the prominent bone may clearly be shelled out from its location. However, if once the extra bone has been removed, the tendon is loose and floppy, suturing or joining together is necessary as a means of connecting it to the residual navicular bone.
Accessory navicular surgery pros:
The benefits of the accessory navicular operation is that the agony in your foot can be minimized so that you can engage once again in your favorite sports. Moreover, surgery is last resort where no other is suitable or able to relieve symptoms. Another benefit of surgery is one time treatment means you don't need to take any pain medications or other for life time to relive pain.
Accessory navicular surgery cons:
The downside here is that, if you want to keep following sports, some doctors can suggest that you avoid surgery. After recovery from surgery, there are doctors who will advise you not to engage in high-impact sports to prevent your symptoms from returning. If this suggestion is issued, then it may be beneficial to get a second view on the issue. Another disadvantage of surgery is recurrence of condition that is less likely but it is reported in some instances. Cost of surgery is another concern for a patient.