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PATHOLOGIES
MIDFOOT AND HINDFOOT CONDITIONS
Painful Accessory Navicular
What is it?
An accessory navicular is an extra piece of bone or cartilage located on the inner side of the foot, next to the navicular bone. It’s a common congenital variant, but in some people it becomes painful due to fracture through the area where the accessory navicular joins to the main navicular, irritation of the surrounding tendon (particularly the tibialis posterior) or pressure from shoe wear.
CAUSES
- Congenital
- Repetitive irritation or trauma
- Overuse of the tibialis posterior tendon
- Poorly fitting footwear or flatfoot alignment
SYMPTOMS
- Pain or swelling on the inner aspect of the midfoot
- Tenderness where shoes or straps rub
- Pain after activity or standing for long periods
DIAGNOSIS
Physical examination and X-rays confirm the presence of the accessory bone. In symptomatic cases, MRI may be used to evaluate associated tendon inflammation.
TREATMENT
- Non-surgical: activity modification, orthotics, anti-inflammatories, and immobilisation
- Surgical (for persistent pain): removal of the accessory bone with repair or advancement of the tibialis posterior tendon
