Overview
Os tibiale navicular refers to an extra bone found in the foot. An accessory bone is a bone that is not normally found in the average human, but in most cases is not considered abnormal. This condition represents a secondary ossification center (growth center) of the navicular bone. It is present from birth. The navicular bone is found on the inside part of the foot.
Causes
Just having an accessory navicular bone is not necessarily a bad thing. Not all people with these accessory bones have symptoms. Symptoms arise when the accessory navicular is overly large or when an injury disrupts the fibrous tissue between the navicular and the accessory navicular. A very large accessory navicular can cause a bump on the instep that rubs on your shoe causing pain.
Symptoms
A visible bony lump on the inner part of the foot, towards the middle, just above the arch of the foot. Redness, swelling, and sensitivity of the bony prominence. Pain or throbbing in the middle of the foot and the arch. Difficulty with foot movement and activity. Possible skin callous or skin irritation caused by footwear rubbing over the lump. Not everyone who has an accessory navicular will develop these problems. When problems do occur, they may begin in early adolescence. The obvious indication is a painful bump on the inside of the foot, which hurts to touch, and causes problems that gradually become worse, and which are aggravated by activity, walking, etc., leading to all the problems discussed here. Pain may be worse towards the end of the day, and continue into the night.
Diagnosis
Typically, accessory navicular syndrome isn?t hard to diagnose. Our podiatrists will examine the lower limb and check the hard prominence, as well as use X-rays to confirm the presence of extra bone tissue. Other diagnostic images may be able to identify inflammation and specific damage to the midfoot. Depending on the severity of your discomfort, conservative measures may be enough to resolve the condition.
Non Surgical Treatment
Rest is the most important factor in relieving your pain. You may need to immobilize your foot to allow the affected tissues to rest enough that they can heal. Icing the area will help decrease any inflammation and swelling. Our staff may recommend anti-inflammatory medications as well. Most likely you will need to change your footwear-and possibly add orthotics-to accommodate your bony prominence and relieve strain in the midfoot. Sometimes physical therapy may be able to help strengthen tissues and prevent additional injuries.
Surgical Treatment
Depending upon the severity the non operative or conservative treatment should be maintained for at least 4- 6 months before any surgical intervention. There are 2 surgeries that can be performed depending upon the condition and symptoms. First is simple surgical excision. In this generally the accessory navicular along with its prominence is removed. In this procedure, skin incision is made dorsally to the prominence of accessory navicular. Bone is removed to the point where the medial foot has no bony prominence over the navicular, between the head of the talus and first cuneiform. Symptoms are relieved in 90% of cases. Second is Kindler procedure. In this the ossicle and navicular prominence is excised as in simple excision but along with the posterior tibial tendon advancement. Posterior tibial tendon is split and advanced along the medial side of foot to provide support to longitudinal arch. After surgery 4 week short leg cast, well moulded into the arch with the foot plantigrade is applied. Partial weight bearing till the 8th week and later full weight bearing is allowed. When the cast is being removed can start building up the ROM to counter atrophy and other physical therapy treatment which include stretching and strengthening exercises.
Os tibiale navicular refers to an extra bone found in the foot. An accessory bone is a bone that is not normally found in the average human, but in most cases is not considered abnormal. This condition represents a secondary ossification center (growth center) of the navicular bone. It is present from birth. The navicular bone is found on the inside part of the foot.
Causes
Just having an accessory navicular bone is not necessarily a bad thing. Not all people with these accessory bones have symptoms. Symptoms arise when the accessory navicular is overly large or when an injury disrupts the fibrous tissue between the navicular and the accessory navicular. A very large accessory navicular can cause a bump on the instep that rubs on your shoe causing pain.
Symptoms
A visible bony lump on the inner part of the foot, towards the middle, just above the arch of the foot. Redness, swelling, and sensitivity of the bony prominence. Pain or throbbing in the middle of the foot and the arch. Difficulty with foot movement and activity. Possible skin callous or skin irritation caused by footwear rubbing over the lump. Not everyone who has an accessory navicular will develop these problems. When problems do occur, they may begin in early adolescence. The obvious indication is a painful bump on the inside of the foot, which hurts to touch, and causes problems that gradually become worse, and which are aggravated by activity, walking, etc., leading to all the problems discussed here. Pain may be worse towards the end of the day, and continue into the night.
Diagnosis
Typically, accessory navicular syndrome isn?t hard to diagnose. Our podiatrists will examine the lower limb and check the hard prominence, as well as use X-rays to confirm the presence of extra bone tissue. Other diagnostic images may be able to identify inflammation and specific damage to the midfoot. Depending on the severity of your discomfort, conservative measures may be enough to resolve the condition.
Non Surgical Treatment
Rest is the most important factor in relieving your pain. You may need to immobilize your foot to allow the affected tissues to rest enough that they can heal. Icing the area will help decrease any inflammation and swelling. Our staff may recommend anti-inflammatory medications as well. Most likely you will need to change your footwear-and possibly add orthotics-to accommodate your bony prominence and relieve strain in the midfoot. Sometimes physical therapy may be able to help strengthen tissues and prevent additional injuries.
Surgical Treatment
Depending upon the severity the non operative or conservative treatment should be maintained for at least 4- 6 months before any surgical intervention. There are 2 surgeries that can be performed depending upon the condition and symptoms. First is simple surgical excision. In this generally the accessory navicular along with its prominence is removed. In this procedure, skin incision is made dorsally to the prominence of accessory navicular. Bone is removed to the point where the medial foot has no bony prominence over the navicular, between the head of the talus and first cuneiform. Symptoms are relieved in 90% of cases. Second is Kindler procedure. In this the ossicle and navicular prominence is excised as in simple excision but along with the posterior tibial tendon advancement. Posterior tibial tendon is split and advanced along the medial side of foot to provide support to longitudinal arch. After surgery 4 week short leg cast, well moulded into the arch with the foot plantigrade is applied. Partial weight bearing till the 8th week and later full weight bearing is allowed. When the cast is being removed can start building up the ROM to counter atrophy and other physical therapy treatment which include stretching and strengthening exercises.