Accessory navicular syndrome

- The accessory navicular (os navicularum or os tibiale externum) 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.  
- An accessory navicular is congenital (present at birth). It is not part of normal bone
structure and therefore is not present in most people.  
- Extra bones in the feet. These bones are called accessory bones.
- The navicular bone is one of the small bones located in the arch of the middle of the foot.
- Most of the time this condition is asymptomatic, and ppl may not aware of it throughout
their life until the pain occurs.
- Pain may occur if the accessory bone is overly large causing this bump to rub against
with the footwear.
- This condition is called as accessory navicular syndrome.
- It can result from any of the following:
 Trauma (foot or ankle sprain)
 Chronic irritation from shoes or other footwear rubbing against the extra bone)
 Excessive activity or overuse
*many ppl with accessory navicular syndrome also have flat feet (fallen arches).
Having a flat foot puts more strain on the posterior tibial tendon, which can produce
inflammation or irritation of the accessory navicular.
- There is muscle (abductor hallucis muscle), ligaments (plantar calcaneonavicular
ligament & parts of deltoid ligament) and tendon (posterior tibial tendon) attach to this
bone. So, when there is injury to the surrounding structures of the navicular bone,
symptoms will arise.
- Fibrous tissues, ligaments and tendons have a poor blood supply and are prone to poor
healing.
- Often, this extra navicular bone lies near or attaches to the posterior tibial tendon.
- When posterior tibial muscle contracts with movements such as foot inversion or
plantar flexion, the posterior tendon moves and the accessory navicular bone moves,
this can cause severe pain in those with ANS.
- Common treatment: RICE, immobilisation, anti-inflammatory medications, cortisone
injections or innotive surgical options. (these treatments will weaken the area in the
foot)
- Prolotherapy is a better choice to strengthen the structures in the medial foot.
- H3 Prolotherapy is a comprehensive injection technique that works to strengthen these
ligament, tendon and muscle attachments by causing a mild anti-inflammatory response
in the tissues.
- Prolotherapy supports the body’s normal healing response to injury. The solution
directed at the injured and weakened tissue will cause an influx of blood supply and
regenerative cells to come to the area.
- As part of this healing cascade, collagen cells will also be deposited at the injured site.
- The tissue, which is made mostly of collagen, will become stronger and tighter as these
new collagen mature.
- It is the opposite of injections like cortisone, which cause the tissue to degenerate but
are often used in chronic foot pain for temporary pain relief.
- The goal of H3 Prolotherapy is a long term curatibe results.
- When the weakness of injured tissues resolved and become healthy again, often times
the symptoms with ANS are resolved and patient no longer suffers from chronic foot
pain. (it may take 3-5 tretaments to fully resolve)
- The signs and symptoms of accessory navicular syndrome include:
 A visible bony prominence on the midfoot (the inner side of the foot, just above the arch)
 Redness and swelling of the bony prominence
 Vague pain or throbbing in the midfoot and arch, usually occurring during or after periods of
activity

- Nonsurgical Treatment Approaches

The goal of nonsurgical treatment for accessory navicular syndrome is to relieve the
symptoms. The following may be used:
 Immobilization. Placing the foot in a cast or removable walking boot allows the affected
area to rest and decreases the inflammation.
 Ice. To reduce swelling, a bag of ice covered with a thin towel is applied to the affected
area. Do not put ice directly on the skin.
 Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen,
may be prescribed. In some cases, oral or injected steroid medications may be used in
combination with immobilization to reduce pain and inflammation.
 Physical therapy. Physical therapy may be prescribed, including exercises and
treatments to strengthen the muscles and decrease inflammation. The exercises may
also help prevent recurrence of the symptoms.
 Orthotic devices. Custom orthotic devices that fit into the shoe provide support for the
arch and may play a role in preventing future symptoms.
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- The Geist classification divides these into three types:

- Type I: is a sesamoid bone in the posterior tibialis tendon. There is a

small gap of approximately 3mm or less between the sesamoid and
the navicular.
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- Type II: consists of an accessory bone, up to 1.2cm in diameter,

where synchondrosis develops between it and the navicular.
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- Type III: is the fused accessory navicular resulting in a large

cornuate shaped navicular.
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