Exercises To Help Accessory Navicular Syndrome Overview The Accessory Navicular is an extra bone or piece of cartilage located on the inner side of the foot just above the arch. It is incorporated within the posterior tibial tendon, which attaches in this area. Some people with this extra bone develop a painful condition known as Accessory Navicular Syndrome when the bone and/or posterior tibial tendon are aggravated.
Causes The syndrome may result from any of the following, previous trauma such as a foot or ankle sprain. Chronic irritation from shoes or other footwear causing friction against the bone. Strain from overuse or excessive activity. Symptoms The catalyst for symptoms might be some sort of injury (such as a broken or sprained ankle), excessive activity, or irritation from where shoes are rubbing on the bony prominence the accessory navicular makes. These can irritate the bone, or make the tendon it?s embedded in (the posterior tibial tendon, remember?) inflamed and sore. Because the tendon is compromised in its ability to support the arch, accessory navicular syndrome almost always leads to flat feet, which is one very obvious symptom. Diagnosis Upon examining a foot with a symptomatic accessory navicular, there will often be a bony prominence on the inside of the foot, just below and in front of the inside ankle bone (medial malleolus). The size of this prominence will vary from small to quite large. Pressing over this area will often cause discomfort. There may be an associated flat foot deformity as this can occur in patients with an accessory navicular. Stressing the posterior tibial tendon by raising the heel up and down on one foot, or by forcing the foot to the inside against resistance, may aggravate the symptoms as these maneuvers stress the posterior tibial tendon which is attached on the inside of the accessory navicular bone. Patients may walk with a slight limp due to the pain. Non Surgical Treatment If the foot becomes painful following a twisting type of injury and an X-ray reveals the presence of an accessory navicular bone, your doctor may recommend a period of immobilization in a cast or splint. This will rest the foot and perhaps allow the disruption between the navicular and accessory navicular to heal. Your doctor may prescribe anti-inflammatory medication. Sometimes an arch support can relieve the stress on the fragment and decrease the symptoms. If the pain subsides and the fragment becomes asymptomatic, further treatment may not be necessary.