Accessory Navicular Bone

The accessory navicular is an extra bone in the foot that is present from birth. While many people may have this bone without any symptoms, in some individuals it can cause pain and limited mobility.

Symptoms often become noticeable in physically active individuals or those who wear improper footwear. If pain or restricted motion related to the accessory navicular is suspected, it's important to consult an orthopedic surgeon or a specialist experienced in foot and ankle surgery as soon as possible to prevent worsening of the condition.

Op. Dr. Utku Erdem Özer, a specialist in foot and ankle surgery based in Istanbul, has extensive knowledge, empathy, and experience in diagnosing and treating conditions related to the accessory navicular bone.

What Is an Accessory Navicular Bone?

An accessory navicular bone is an extra bone located on the inner side of the foot, adjacent to the navicular bone. It is congenital (present at birth) and may remain unnoticed throughout life. However, in some people, it can cause discomfort, pain, and limited movement.

What Are the Symptoms of an Accessory Navicular?

Although it is often asymptomatic, the accessory navicular may lead to symptoms such as:

• Pain on the inner side or arch of the foot

• Swelling and tenderness

• Increased pain after prolonged standing or physical activity

• Discomfort due to pressure from tight or ill-fitting shoes

This condition is commonly seen in athletes and may be associated with stress fractures or other overuse injuries. To learn more about similar conditions, you can also explore information on stress fractures in the foot.

How Is Accessory Navicular Diagnosed?

Diagnosis is made through a detailed physical examination and imaging studies. X-rays, MRI, or CT scans help identify the location of the accessory navicular and its relationship with surrounding tissues.

Treatment Options for Accessory Navicular Syndrome

Non-surgical approaches are typically the first choice in managing Accessory Navicular Syndrome. These conservative treatment options may include:

• Rest and activity modification

• Use of orthopedic insoles and supportive footwear

• Anti-inflammatory medications for pain relief

• Physical therapy and rehabilitation programs

If you have questions about your treatment or rehab process, feel free to contact us via our contact page.

Accessory Navicular Syndrome Surgery

When conservative methods fail to provide adequate relief, surgical treatment for Accessory Navicular Syndrome may be considered. Before deciding on surgery, it is essential to evaluate whether the accessory navicular bone is accompanied by the following two conditions:

• Posterior Tibial Tendon Dysfunction (PTTD)

• Adult Acquired Flatfoot Deformity (AAFD)

While conservative methods are often sufficient, some cases may require surgery. For similar severe foot and ankle conditions, you can also read our article on Achilles Tendon Rupture and Surgery.

Accessory Navicular Bone and Posterior Tibial Tendon Dysfunction

The accessory navicular bone is located at the insertion point of the posterior tibial tendon, which plays a key role in maintaining the arch of the foot and stabilizing the ankle. The presence of an accessory bone at this site may cause friction and pressure, leading to tendon weakening and dysfunction.

Common Causes:

• Chronic Overuse: Unsupportive footwear, excessive physical activity

• Repetitive Microtrauma: Especially in sports

• Anatomical Variations: Prominent accessory navicular structures

Symptoms:

• Pain and tenderness on the inner side of the foot

• Flattening of the foot arch (flatfoot)

• Pain that worsens with activity

• Swelling and weakness in the foot or ankle

Diagnosis:

• Physical Examination

• Imaging: X-rays, ultrasound, or MRI to evaluate the bone and tendon

Treatment Options:

• Non-surgical: Rest, proper footwear, physical therapy, medications

• Injections: Cortisone, PRP (Platelet-Rich Plasma), exosome therapy

• Surgical: Removal of the accessory bone and tendon repair

Accessory Navicular Bone, PTTD, and Adult Acquired Flatfoot Deformity (AAFD)

Accessory navicular bone, posterior tibial tendon dysfunction (PTTD), and adult acquired flatfoot deformity (AAFD) are interconnected conditions that can cause chronic pain and foot deformity.

1. Causes:

• Accessory Bone: Causes pressure and mechanical inefficiency at the tendon attachment

• PTTD: As the tendon weakens, the arch of the foot collapses

• Flatfoot: Over time, this leads to structural deformity and functional impairment

2. Symptoms:

• Pain and swelling on the inside of the foot

• Collapse of the foot arch

• Increased pain after activity

• Weakness and instability in the ankle

3. Diagnosis:

• Clinical Evaluation: Inspection of arch height and tendon function

• Imaging: X-ray, MRI, or ultrasound for detailed structural assessment

4. Treatment:

Conservative:

• Rest, proper footwear, and custom orthotics

• Physical therapy and rehabilitation

• Cortisone, PRP, or exosome injections

Surgical:

• Removal of the accessory navicular bone

• Posterior tibial tendon repair and reinforcement

• Arch reconstruction procedures

Risks of Accessory Navicular Surgery

Accessory navicular surgery is generally recommended in cases of severe pain or foot deformity. The procedure often involves removal of the accessory bone and repair of the posterior tibial tendon. However, like any surgical intervention, it carries certain risks that should be carefully considered.

Common surgical risks include infection, bleeding, and nerve injury. Additionally, some patients may continue to experience pain or incomplete restoration of tendon function during the recovery period. Therefore, the decision for surgery must be made thoughtfully, in consultation with a qualified orthopedic specialist.

Potential Risks of Surgery:

• Infection: The surgical site may become infected.

• Nerve Injury: Temporary or permanent numbness or tingling in the foot may occur.

• Prolonged Recovery: Full recovery may take several months depending on the individual and surgical technique used.

Conclusion

While the accessory navicular bone often remains unnoticed and symptom-free throughout life, in some individuals it may cause pain, limited mobility, and even contribute to the development of flatfoot deformity. Early diagnosis and appropriate treatment are critical in preventing the progression of the condition and avoiding permanent damage.

The treatment process typically begins with non-surgical methods, but when necessary, it may include surgical procedures aimed at improving function and quality of life.

Thanks to the expertise and extensive surgical experience of Op. Dr. Utku Erdem Özer, accessory navicular syndrome and related conditions can be effectively managed—helping patients return to a healthy, pain-free life.Don't ignore your foot health—consult a specialist if you experience any symptoms.