Introduction:
Around 2.5 % of people are born with an auxiliary navicular (accessory naviculars are also termed auxiliary naviculars). The navicular bone is one of the seven bones that frame the ankle and the foot. Early on in childhood, no one notices this issue. However, the hump on the inside of the arch only becomes noticeable throughout adolescence when the auxiliary navicular starts to calcify. Typically, it never manifests as a symptom. However, for some people, an injury of some kind, such as a fall, misstep, or twist, causes the auxiliary navicular to be symptomatic.
What Are the Reasons Behind Accessory Navicular Bone Syndrome?
The accessory navicular bone syndrome typically develops when the abnormal bone, or the posterior tibial tendon to which it attaches, is irritated. This may be the result of the following:
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Traumatic injury to the foot or ankle.
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Constant rubbing of footwear against the bone.
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Excessive exercise or overuse.
Flat feet are common among people with accessory navicular syndrome, which makes the problem worse since they place additional strain on the posterior tibial tendon.
What Are the Types of Accessory Navicular?
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The auxiliary navicular comes in three varieties. Just medial (inside) the navicular bone, this additional cartilage that develops into bone is located and linked to the posterior tibial tendon.
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The posterior tibial tendon's insertion may be impacted by the auxiliary navicular. This tendon helps to maintain an arch and keeps the foot in alignment.
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The auxiliary navicular can sometimes be linked to a flat (pes planus) foot in addition to a normal foot posture and alignment.
How Is the Patient Examined for Accessory Navicular Syndrome?
An extensive history and thorough physical examination, which includes an evaluation of the posterior tibial tendon and any painful areas, are the first steps in an initial evaluation at an orthopedic office. Ankle and foot misalignments that are related should be noticed.
Last but not least, weight-bearing foot X-rays will aid in the diagnosis. Magnetic resonance imaging (MRI) may occasionally be required to determine whether the posterior tibial tendon is contributing to the symptoms or gaining greater insight into the anatomy of the auxiliary navicular.
What Are the Treatment Modalities for Accessory Navicular Syndrome?
The initial course of action is cautious. A medial heel wedge, NSAIDs (non-steroidal anti-inflammatory drugs), and physical therapy may be beneficial during the initial symptomatic phase. Before beginning the wedge and physical therapy, a cast or boot may be required if the injury is extremely severe for a brief period of time.
An injection of steroids is hardly ever necessary or advised. Patients can continue their normal routines when their discomfort subsides. Arch support or personalized orthotics may be able to relieve some of the added pressure on the auxiliary navicular and the posterior tibial tendon in a small percentage of patients. Surgery may be an option for people who have not responded to conservative treatment or who experience recurrent problems. During surgery, the auxiliary navicular must be removed, and the posterior tibial tendon must be reattached.
What Is the Non-surgical Treatment of Accessory Navicular Bone Syndrome?
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Symptom management, not deformity correction, is the goal of conservative (non-surgical) therapies for the accessory navicular syndrome.
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Non-steroidal anti-inflammatory drugs (NSAIDs) are frequently suggested to minimize tissue swelling. In order to provide relief, steroids and a local anesthetic can be injected directly into the afflicted area of the foot.
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Sometimes, the injured foot is temporarily immobilized while the inflammation around the bone heals. For this, one can utilize a walking boot with a removable sole. Additionally, patients can be advised to modify their routines and, to the maximum extent possible, rest the injured foot. Ice treatments might also lessen tissue irritation.
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Custom inserts and similar devices may be advised if arch problems are causing pain from the accessory navicular syndrome. Some patients claim that physical therapy activities to build up the muscles and other soft tissues that support the afflicted foot have significantly reduced their symptoms.
The syndrome of the auxiliary navicular bone can be treated in a number of ways.
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Immobilization with a cast or walking boot.
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Applications of ice packs.
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Non-steroidal anti-inflammatory drugs (NSAIDs).
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Injected steroids.
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Orthotics.
The first four techniques are intended to lessen discomfort and edema (swelling). The two that are left aim to build up the muscles, realign the foot properly, and stop the damage from happening again.
What Is the Surgical Treatment of Accessory Navicular Bone Syndrome?
An anomaly like accessory navicular syndrome cannot be avoided. However, one can choose wisely in terms of how to take care of the feet. The chances of reacting favorably to treatment suggestions can be improved by wearing cozy footwear that offers adequate support and obtaining medical attention for any unexpected or worsening foot pain. The disorder known as the accessory navicular syndrome is hereditary. However, every individual will experience it differently. The most popular surgical remedy for auxiliary navicular bone conditions is Kidner surgery.
The bone is separated from the posterior tibial tendon during this treatment, and the tendon is then completely removed from the foot. After that, the tibial tendon is reattached, and the wound is stitched up. After surgery, patients are likely to utilize crutches and a light cast. After about six weeks, they should be ready to resume their regular physical activities. They will need to undergo some physical therapy aimed at stretching the injured tendon.
Conclusion:
In conclusion, an accessory navicular is a relatively uncommon lesion that rarely manifests any symptoms. Non-surgical treatment is frequently effective. Surgical intervention is only necessary in a small percentage of cases. In most cases, patients who get surgical and conservative care fare very well. Once the patient's symptoms have subsided or after they have fully healed from surgery, athletic activity can typically be resumed. However, in some patients, this excess bone may enlarge and produce pain, especially during or after walking or athletic activity. In many cases, this extra bone does not create any issues and does not need to be treated. The majority of the time, the accessory navicular bone condition can be managed without surgery, although this is not always the case.
