Exercises For Accessory Navicular Syndrome

Overview
Sometimes, feet do weird things. For instance, about 10% of the general population?s feet have decided that having an extra bone in the mix is a really great idea. This extra bone (or sometimes a bit of cartilage), is called an accessory navicular. It shows up in a tendon called the posterior tibial tendon (which is a fancy name - but just remember, it helps support the arch of the foot) on the middle of the inside of the foot, just above the arch. This extra little bone is present from birth, so it?s not something that?ll suddenly grow later in life. Now, accessory navicular syndrome is when that extra bone starts causing issues with your shoe-wearing, or even the shape and function of your foot. It?s the syndrome you want to worry about, not necessarily the extra bone itself.



Causes
An injury to the fibrous tissue connecting the two bones can cause something similar to a fracture. The injury allows movement to occur between the navicular and the accessory bone and is thought to be the cause of pain. The fibrous tissue is prone to poor healing and may continue to cause pain. Because the posterior tibial tendon attaches to the accessory navicular, it constantly pulls on the bone, creating even more motion between the fragments with each step.

Symptoms
Many people with an accessory navicular do not experience symptoms, however some may notice a bump and/or swelling on the inside of the foot just above the arch. They may also experience pain in the middle of the foot, particularly with physical activity.

Diagnosis
To diagnose accessory navicular syndrome, medical staff ask about the patient?s activities and symptoms. They will examine the foot for irritation or swelling. Medical staff evaluate the bone structure, muscle, joint motion, and the patient?s gait. X-rays can usually confirm the diagnosis. MRI or other imaging tests may be used to determine any irritation or damage to soft-tissue structures such as tendons or ligaments. Because navicular accessory bone irritation can lead to bunions, heel spurs and plantar fasciitis, it?s important to seek treatment.

Non Surgical Treatment
Patients with a painful accessory navicular may benefit with four to six physical therapy treatments. Your therapist may design a series of stretching exercises to try and ease tension on the posterior tibial tendon. A shoe insert, or orthotic, may be used to support the arch and protect the sore area. This approach may allow you to resume normal walking immediately, but you should probably cut back on more vigorous activities for several weeks to allow the inflammation and pain to subside. Treatments directed to the painful area help control pain and swelling. Examples include ultrasound, moist heat, and soft-tissue massage. Therapy sessions sometimes include iontophoresis, which uses a mild electrical current to push anti-inflammatory medicine to the sore area.



Surgical Treatment
Surgical treatment of the accessory navicular syndrome with simple excision has the advantages of less invasive to the posterior tibial tenden and the medial longitudinal arch of the foot, shorter time of immobilization of the foot and stay in hospital, small incision and good clinical results. This procedure is one of the best selective treatments for the accessory navicular syndrome, especially for the patients without flatfoot deformity and old sprain injury.