The accessory navicular is an extra bone or bit of cartilage within the arch of the foot that may or might not bring about problems. Also, it is often known as an os navicularum or os tibiale externum. It is included inside the tendon of the posterior tibial muscle which inserts in the region. The additional bone is on the inside side of the navicular bone that is the bone that is towards the top of the arch of the foot. It is present in between 5-15% of the population. It’s not usually a concern, however the prominence of the accessory bone might make force from the footwear painful. Sometimes the bone is in such a location which it does affect the angle of pull with the posterior tibial muscle that might affect foot biomechanics and would cause any number of dysfunctional problems, like a flat foot.

The diagnosis is frequently by x-ray where the presence of the extra bone is obvious. There are many varieties that the x-ray might help ascertain which one it is. The Geist grouping separates the accessory navicular bones in to 3 different types. Each one of the 3 varieties has an effect on the structure and biomechanics of the feet in different ways and each of the 3 differing types must have a different therapy approach.

The aim of treatment methods are to relieve the symptoms and stop it remaining painful. In the event the pain is particularly bad, then putting the foot within a plaster cast or removable walking boot allows the affected region to rest which helps the pain. Ice can also be used to relieve swelling. By mouth nonsteroidal anti-inflammatory drugs (NSAIDs) can be employed in conjunction with immobilization to help decrease the swelling and pain. Physical exercises and therapies to strengthen the muscles can also be suggested, especially over the long term to help you prevent a recurrence of the symptoms. Foot orthotic devices are generally also very helpful to defend the foot and become especially useful in the event the accessory navicular is bringing about a flat foot.

The accessory navicular can certainly be a particular dilemma is sports for example skiing as well as ice skating. It is because the footwear of these sports activities goes around the feet and its fairly rigid. So, if someone has a prominent piece of bone on the foot, such as an accessory navicular, this could be really painful and also not easy to handle. Things like donut type cushioning to deflect the force coming from the shoes off the prominence is oftentimes valuable. This is also where the expertise of a boot maker or a experienced ski boot fitter can be indispensable. They are used to dealing with these kinds of challenges and can change the boot around the accessory bone to make it more comfortable. A podiatric doctor can frequently assist with all this.

When the conservative non-surgical methods really don’t ease the pain, after that surgery can be indicated. Surgical procedures might entail taking out the accessory bone, reshaping the region and correcting the tendon insertion to better its biomechanics. This extra bone is not really required for normal foot function, therefore theoretically it will not be missed.


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Craig Payne Author
University lecturer, runner, cynic, researcher, skeptic, forum admin, woo basher, clinician, rabble-rouser, blogger, dad.