Does Accessory Navicular Syndrome Always Warrant Surgery

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Overview
There are three different types of accessory navicular. This extra cartilage, which is turned into bone, is found attached to the posterior tibial tendon, just medial (inside) the navicular bone. The accessory navicular can affect the insertion of the posterior tibial tendon. This tendon has a job of keeping your foot aligned and helping to maintain an arch. The accessory navicular can be associated with a normal foot posture and alignment, or sometime with a flat (pes planus) foot.

Accessory Navicular Syndrome

Causes
Like all painful conditions, ANS has a root cause. The cause could be the accessory navicular bone itself producing irritation from shoes or too much activity. Often, however, it is related to injury of one of the structures that attach to the navicular bone. Structures that attach to the navicular bone include abductor hallucis muscle, plantar calcaneonavicular ligament (spring ligament) parts of the deltoid ligament, posterior tibial tendon.

Symptoms
The main symptom of an aggravated accessory navicular is pain, particularly in the instep. Walking can sometimes be difficult, and tight shoes may worsen the condition.

Diagnosis
Accessory navicular syndrome is diagnosed by asking about symptoms and examining the foot for skin irritation and swelling. Doctors may assess the area for discomfort by pressing on the bony prominence. Foot structure, muscle strength, joint motion and walking patterns may also be evaluated.

Non Surgical Treatment
The foot may be placed in How do I stretch my Achilles tendon? a cast or removable walking boot to allow the affected area to rest and decrease the inflammation. Physical therapy including exercises and treatments to strengthen the muscles, decrease inflammation, and prevent recurrence of the symptoms. Custom orthopedic devices that fit into the shoe providing arch support. Even after successful treatment, symptoms may reappear.

Accessory Navicular Syndrome

Surgical Treatment
If your pain and discomfort don’t go away with treatments like these, then it may be time to consider surgery. If you decide to go through with it, your surgeon will probably remove the accessory navicular once and for all, and will tighten up the posterior tibial tendon in order to make it better able to support your arch. You’ll probably have to wear a cast for a several weeks, and a brace for some months after that, but with patience, you may be able to say goodbye to your symptoms.

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